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Billing code

C163A — Nephrology medical specific assessment – hospital in-patient

Nephrology in-patient specialist assessment

Bill C163 for a nephrologist's full history of the presenting complaint and detailed exam of the affected systems for a hospital in-patient.

Watch for: One per patient per physician per 12 months, unless the diagnosis is clearly different; extras pay as a lesser assessment.

Code

C163A

Description

Nephrology medical specific assessment – 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

Nephrology assessment of a hospital in-patient with a full history of the presenting complaint and a detailed exam of the affected systems.

What it covers

A medical specific assessment is a specialist assessment, not in the patient's home, with a full history of the presenting complaint and a detailed exam of the affected parts, regions or systems needed to make a diagnosis, exclude disease or assess function (GP23).

C163 is the non-emergency hospital in-patient version (A137). When you admit a patient you haven't assessed for the same illness in the prior 90 days, the admission assessment can be a medical specific assessment (GP40).

Billing rules

• Limited to 1 per patient per physician per 12 months, or 2 if the second is for a clearly different diagnosis or is a hospital admission assessment at least 90 days after the last one; excess is paid as a lesser assessment (GP23).
• Medical specific assessments and complex medical specific re-assessments combined are limited to 4 per patient per physician per 12 months (GP23).
• Only one consultation or assessment per admission when a patient is transferred between physicians in the same hospital (GP40).
• Seeing patients in the ED or out-patient department while not on ED duty uses the A-prefix General Listings, not C-codes (A130, A137).
• For chronic dialysis patients, admission assessments and subsequent visits to acute care in-patients for complications of dialysis, chronic renal disease or intercurrent illness are not included in the dialysis team fee and are billed separately (J39).
• By video only, and for in-patients or LTC residents only when you are not the MRP, no local physician with the expertise is available (documented by the referrer), and the referrer saw the patient in person within the prior 30 days (AJ2, A69).

Common rejections

• AT2: Billed by telephone (K301A). This code is on Appendix J's video-only list, so it must be done by video and claimed with K300A (AJ2).

Related codes: A163, C164, C161, C165, C162

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Nephrology (16), page A137; rules GP23, GP40.

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