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Billing code

C255A — Endocrinology limited consultation – hospital in-patient

Endocrinology in-patient limited consultation

Bill for an endocrinologist's consultation on a hospital in-patient that is less demanding and takes much less time than a full consultation.

Watch for: Include the referrer's billing number from the signed written request; without it, it pays as a lesser assessment.

Code

C255A

Description

Endocrinology limited 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

Limited consultation by an endocrinologist for a hospital in-patient: a less demanding consultation that takes much less time than a full one.

What it covers

A limited consultation is a consultation that is less demanding and normally needs substantially less of your time than a full consultation. Otherwise it has the same requirements as a full consultation (GP19).

C255 is the in-patient code; A255 is the office code and W255 the long-term care code (A98, A102, A103).

Billing rules

• Needs a written, signed request naming you or the specialty, the referrer and their billing number, and the patient and health number, kept in your chart; otherwise it pays as a lesser assessment (GP16).
• A written report with your findings and recommendations goes to the referrer (GP16).
• Consultations for the same patient and diagnosis are limited to one per two consecutive 12-month periods (a second is allowed only for a hospital in-patient or ED patient 12 to 24 months after the first); an unrelated diagnosis allows one per 12 months. Excess claims pay as an assessment (GP17, GP18).
• Detention (K001) is only payable after 60 minutes (GP29, GP30).
• Patients under 16 get an age premium of 10% to 30%, depending on age (GP64).
• By video only for an in-patient or long-term care resident, and 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 the past 30 days (Appendix J AJ2, A69).

Common rejections

• ARP: OHIP needs the referring provider's number on a consultation claim; add the referrer's billing number from the written request and resubmit (GP16).

Related codes: A255, W255, C155, C156, C153

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Endocrinology & Metabolism (15), page A102; rules GP16–GP19.

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