< Billing codes

Billing code

C235A — Ophthalmology consultation – hospital in-patient

Ophthalmology in-patient consultation

Bill when an ophthalmologist consults on a non-emergency hospital in-patient at the written request of a physician or nurse practitioner.

Watch for: Include the referrer's billing number; over the consultation limits, it pays as a specific assessment.

Code

C235A

Description

Ophthalmology 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

Ophthalmology consultation for a non-emergency hospital in-patient, on a written request from a physician or nurse practitioner.

What it covers

The in-patient version of the ophthalmology consultation, for non-emergency hospital in-patient services (A162).

A consultation needs a written request, a general or specific assessment with review of relevant data, and a written report to the referrer (GP16). In hospital, the request can be on the common medical record (GP16).

Billing rules

• Consultation limits apply: same diagnosis 1 per 2 consecutive 12-month periods, with a second allowed for an in-patient or ED patient 12–24 months after the first; unrelated diagnosis 1 per 12 months (GP17).
• Over the limits, it pays as a specific assessment (GP17–GP18).
• In-patient rules apply (GP40–GP48). For emergency calls and other special visits to in-patients, use the general listings (A-prefix) and special visit premiums instead (A162).
• Age premiums for patients under 16 apply to specialist consultations (GP64).
• Video only. For an in-patient, virtual care is payable 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 30 days (AJ2, A69).

Common rejections

• ARF: The claim is missing the referring provider's number. A consultation needs a written request that names the referring physician or nurse practitioner and their billing number (GP16).
• AT2: Must include video modality: C235 is video-only by virtual care (AJ2).

Related codes: A235, C236, C935, C233, C232, C238

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Ophthalmology (23), page A162.

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