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Billing code

C250A — Retinopathy of prematurity assessment – hospital in-patient

In-patient retinopathy of prematurity assessment

Bill for an ophthalmologist's retinopathy of prematurity assessment of a hospital in-patient aged 9 months or under, or older with stage 3 disease.

Watch for: No other assessment or consultation by you for the same patient on the same day is payable.

Code

C250A

Description

Retinopathy of prematurity assessment – 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

Retinopathy of prematurity (ROP) assessment for a hospital in-patient, under the same conditions as A250. No other assessment same day.

What it covers

The in-patient version of A250, subject to the same conditions (A162).

An ROP assessment is an initial or follow-up assessment by an ophthalmologist of a patient with ROP who is 9 months of age or younger, or aged 10 months to 16 years with at least stage 3 ROP disease (A156).

Billing rules

• Patients 9 months or younger, or 10 months to 16 years with minimum stage 3 ROP (A156).
• No other assessment or consultation by the same physician for the same patient on the same day is payable (A156, A162).
• 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).
• Detention (K001) may start after 60 minutes (GP30).
• Not listed in Appendix J, so not payable as a virtual service (AJ1–AJ2).

Often billed with

• E125/E126 laser retinopexy for ROP, when treatment is needed (Y8).
• G823 OCT for patients under 18 (J93).

Related codes: A250, E125, E126, G823, C233

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

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