< Billing codes

Billing code

C243A — Otolaryngology in-patient specific assessment

Otolaryngology in-patient specific assessment

Bill when an otolaryngologist takes a full history of the complaint and examines the affected area of a hospital in-patient.

Watch for: If you assessed the patient for the same illness within 90 days before admission, bill C244 re-assessment instead.

Code

C243A

Description

Otolaryngology in-patient specific assessment

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

Specific assessment of a hospital in-patient by an otolaryngologist: full history of the complaint and detailed exam of the affected area.

What it covers

C243 is the in-patient specific assessment by an otolaryngologist (A166): a full history of the presenting complaint and a detailed exam of the affected part(s), region(s) or system(s) (GP23).

It is used for the admission assessment when you haven't assessed the patient for the same illness in the past 90 days (GP40).

Billing rules

• Specialists bill from the Consultations and Visits listing of their own specialty (GP9).
• Limit: one per patient per physician per 12 months, or two if the second visit is for a clearly different, unrelated diagnosis. Excess pays as a lesser assessment (GP23).
• If you assessed the patient for the same illness within 90 days before admission, the admission assessment is a specific re-assessment (C244) instead (GP40).
• A surgeon can't bill the hospital admission assessment unless it is the major pre-operative visit (GP40, SP2).
• In-patient visits: see GP40–GP48. For emergency calls and special visits to in-patients, use the General Listings (A prefix) and premiums (A166).
• Video only for in-patients, and only if you aren't the MRP, no local physician with the expertise is available, and the referrer saw the patient in person within 30 days (AJ2, A69).

Often billed with

• E082 admission assessment by the MRP (+30%) when you are the MRP (GP42).

Related codes: C244, C245, A243, C242

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

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