Billing code
C164A — Nephrology medical specific re-assessment – hospital in-patient
Nephrology in-patient re-assessment
Bill C164 for a nephrologist's in-patient re-assessment with a full relevant history and exam of one or more systems.
Watch for: Limited to 2 per patient per physician per 12 months, except admission re-assessments; extras pay as a lesser assessment.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $72.00 | $0.00 | $0.00 | $0.00 |
- Code
- C164A
- Description
- Nephrology medical specific re-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 re-assessment of a hospital in-patient with a full relevant history and exam of one or more systems.
What it covers
A medical specific re-assessment is a specialist service with a full, relevant history and physical exam of one or more systems (GP23).
C164 is the in-patient version (A137). If you assessed the patient for the same illness within 90 days before admitting them, the admission assessment is a re-assessment (GP40).
Billing rules
- Limited to 2 per patient per physician per consecutive 12 months, except re-assessments done for hospital admissions; excess is paid as a lesser assessment (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: A164, C163, C161, C162, C166
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Nephrology (16), page A137; rules GP23, GP40.
APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing