What are the billing rules for C242A?

Subsequent visit limits: one per day for the first 5 weeks after admission, 3 per week in weeks 6–13, and 6 per month after week 13. Excess visits are not payable (GP43). If the patient was referred to you in hospital, count from the date you first assessed them; if care was transferred to you, count from the actual admission date (GP43). For surgeons, the count starts from the admission date if you admitted the patient, or from the referral date if referred to you in hospital (SP2).

What is C242A often billed with?

E083 subsequent visit by the MRP premium (GP47).

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Billing code

C242A — Otolaryngology in-patient subsequent visit – first 5 weeks

Q: What is OHIP billing code C242A?

Routine hospital visit by an otolaryngologist after the admission assessment, during the first five weeks of the stay.

Otolaryngology hospital visit, weeks 1–5

Bill for an otolaryngologist's routine hospital visit after the admission assessment, during the first five weeks of the stay.

Watch for: One per patient per day; use C247 for weeks 6 to 13 and C249 after week 13.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$31.00	$0.00	$0.00	$0.00

Code: C242A
Description: Otolaryngology in-patient subsequent visit – first 5 weeks
FHO+ basket: Not in the FHO+ base rate basket (Schedule 2 or 2B).
Effective date: Jun 1, 2025
Termination date: No end date

Explanation

Updated October 26, 2026

Routine hospital visit by an otolaryngologist after the admission assessment, during the first five weeks of the stay.

What it covers

A subsequent visit is any routine assessment in hospital after the admission assessment (GP43). C242 covers the first five weeks after admission for Otolaryngology (A166).

Weeks 6–13 use C247 and after week 13 use C249 (A166).

Billing rules

Subsequent visit limits: one per day for the first 5 weeks after admission, 3 per week in weeks 6–13, and 6 per month after week 13. Excess visits are not payable (GP43).
If the patient was referred to you in hospital, count from the date you first assessed them; if care was transferred to you, count from the actual admission date (GP43).
For surgeons, the count starts from the admission date if you admitted the patient, or from the referral date if referred to you in hospital (SP2).
As the MRP you can add E083 (+30%) to subsequent visits, if the hospital-payment condition is met. E084 (weekend) doesn't apply to specialty 24 (GP47).
Seeing another physician's patient on an emergency basis uses the General Listings (A prefix) (GP43).
Surgical fees include care until the first post-operative visit (SP1).

Often billed with

E083 subsequent visit by the MRP premium (GP47).

Related codes: C247, C249, C248, C121, C122, C124

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Otolaryngology (24), page A166.

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