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Billing code

C166A — Nephrology repeat consultation – hospital in-patient

Nephrology in-patient repeat consultation

Bill C166 when the same nephrologist consults again on an in-patient's same problem after another physician's care in between.

Watch for: Needs a new signed written request; if repeat conditions aren't met, it is paid as an assessment.

Code

C166A

Description

Nephrology repeat 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

Repeat nephrology consultation for a hospital in-patient: same nephrologist, same problem, after another physician's care in between.

What it covers

A repeat consultation is by the same consultant for the same presenting problem, after another physician has cared for the patient since your first consultation. It needs a new written request (GP19).

C166 is the non-emergency hospital in-patient version (A137).

Billing rules

• Needs a new written, signed request from the referring physician or nurse practitioner (GP19).
• Repeat consultations do not count toward the consultation limits; if the repeat-consultation conditions aren't met, it is paid as an assessment (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).
• 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: C165, C865, A166, C164, W166

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Nephrology (16), page A137; rules GP18–GP19.

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