< Billing codes

Billing code

C249A — Otolaryngology in-patient subsequent visit – after week 13

Otolaryngology hospital visit, week 14+

Bill for an otolaryngologist's routine hospital visit after the 13th week of the stay.

Watch for: Maximum 6 per patient per month; bill an extra visit for an acute intercurrent illness as C121 instead.

Code

C249A

Description

Otolaryngology in-patient subsequent visit – after week 13

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 thirteenth week of the stay; up to 6 per patient per month.

What it covers

C249 is the subsequent in-patient visit by an otolaryngologist after the thirteenth week of the stay, maximum 6 per patient per month (A166).

A subsequent visit is any routine assessment in hospital after the admission assessment (GP43).

Billing rules

• Maximum 6 per patient per month; visits over the limit are not payable (A166, GP43).
• A visit needed for an acute intercurrent illness beyond the limit is C121, which isn't subject to the monthly limit (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).

Often billed with

• E083 subsequent visit by the MRP premium (GP47).

Common rejections

• AM1: OHIP describes this as 'Service limit exceeded': more than 6 subsequent visits in a month after week 13 (GP43).

Related codes: C242, C247, C121, C248

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