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Billing code

C165A — Nephrology consultation – hospital in-patient

Nephrology in-patient consultation

Bill C165 for a nephrologist's non-emergency consultation on a hospital in-patient, at the written request of a physician or nurse practitioner.

Watch for: The signed request must name the referrer and their billing number, or it is paid as a lesser assessment.

Code

C165A

Description

Nephrology 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 a nephrologist for a non-emergency hospital in-patient, at the written request of another physician or nurse practitioner.

What it covers

A consultation is an assessment requested in writing by a physician or nurse practitioner because of the complexity, seriousness or obscurity of the case, or a request for another opinion; it includes a written report to the referrer (GP16).

C165 is the non-emergency hospital in-patient version of the nephrology consultation (A165) (A137). In hospital, the written request may be on the common medical record (GP16).

Billing rules

• Needs a written, signed request from a physician or nurse practitioner that names you or your specialty, the referrer and their billing number, and the patient's health number; otherwise it is paid as a lesser assessment (GP16).
• Same patient, same diagnosis: one consultation per two consecutive 12-month periods (a second only for a hospital in-patient or ED patient 12–24 months after the first); a clearly unrelated diagnosis allows one per 12 months. Excess claims are paid as an assessment (GP17–GP18).
• Detention (K001) can start only after 60 minutes and is assessed on an IC basis with a written explanation (GP30–GP31).
• Age premiums apply for patients under 16, from +10% to +30% depending on age (GP64).
• 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 emergency calls and other special visits to in-patients, bill the A-prefix General Listings with special visit premiums instead (A130, A137; GP65–GP78).
• 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

• ARF: The claim has no referring provider number. A consultation must follow a written referral that identifies the referring physician or nurse practitioner and their billing number (GP16).
• 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: A165, C160, C865, C166, C162, C168

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Nephrology (16), page A137; rules GP16–GP18, GP40.

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