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Billing code

C155A — Endocrinology consultation – hospital in-patient

Endocrinology in-patient consultation

Bill C155 for an endocrinologist's consultation on a hospital in-patient, at the request of a referring physician or nurse practitioner.

Watch for: Add the referrer's billing number from the signed written request, or OHIP rejects or pays a lesser assessment.

Code

C155A

Description

Endocrinology consultation – hospital in-patient

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Consultation by an endocrinologist for a hospital in-patient, at the request of a referring physician or nurse practitioner.

What it covers

A consultation is an assessment done after a written request from a physician, nurse practitioner or (for hospital dental procedures) a dental surgeon who wants your opinion because of the complexity, seriousness or obscurity of the case, or because the patient asks for another opinion (GP16).

It includes a general, specific or medical specific assessment, review of relevant data and a written report with findings, opinions and recommendations to the referrer (GP16). C155 is the in-patient code; A155 is the office code and W155 the long-term care code (A98, A102, A103).

Billing rules

• Needs a written, signed request naming you or the specialty, the referrer and their billing number, and the patient and health number, kept in your chart; otherwise it pays as a lesser assessment (GP16). In hospital, the request may be on the common medical record (GP16).
• Consultations for the same patient and diagnosis are limited to one per two consecutive 12-month periods (a second is allowed only for a hospital in-patient or ED patient 12 to 24 months after the first); an unrelated diagnosis allows one per 12 months. Excess claims pay as an assessment (GP17, GP18).
• If you admit the patient after seeing them, your consultation in the ED or out-patient department counts as the admission assessment (GP40).
• Only one consultation or assessment is payable per admission when an in-patient is transferred between physicians in the same hospital (GP40).
• Detention (K001) is only payable after 60 minutes spent on the consultation (GP29, GP30).
• Patients under 16 get an age premium of 10% to 30%, depending on age (GP64).
• By video only for an in-patient or long-term care resident, and only if you aren't the MRP, no local physician with the expertise is available (documented by the referrer), and the referrer assessed the patient in person within the past 30 days (Appendix J AJ2, A69).
• For emergency calls and other special visits to in-patients, bill the General Listings (A-prefix) code with the special visit premium instead (A102, GP65).

Often billed with

• E082 MRP admission premium (+30%) when this is your admission assessment and you are the MRP (GP42).
• K001 detention after the first 60 minutes (GP30).

Common rejections

• ARP: OHIP needs the referring provider's number on a consultation claim; add the referrer's billing number from the written request and resubmit (GP16).

Related codes: A155, W155, C150, C255, C156, C153, E082, K001

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Endocrinology & Metabolism (15), page A102; rules GP16–GP18, GP40.

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