< Billing codes

Billing code

C260A — Special paediatric consultation – hospital in-patient

Special paediatric in-patient consultation

Bill for a paediatric consultation on a hospital in-patient with at least 75 minutes of direct patient contact.

Watch for: Record start and stop times in the patient's chart, or the service isn't eligible for payment.

Code

C260A

Description

Special paediatric 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

Paediatric in-patient consultation with at least 75 minutes of direct patient contact. Same conditions as A260.

What it covers

A special paediatric consultation includes all the elements of a consultation (A265) plus at least 75 minutes in direct contact with the patient, not counting time on other separately billable services (A168).

C260 is the hospital in-patient version and is subject to the same conditions as A260 (A173).

Billing rules

• Minimum 75 minutes of direct contact with the patient (A168).
• Time counts only direct contact with the patient, not other separately billable services or non-patient-facing work such as chart or imaging review (A168, A169).
• Record start and stop times in the patient's permanent record, or the service is not eligible for payment (A168).
• Needs a written, signed request from the referring physician or nurse practitioner naming the patient, the referrer's billing number and the reason; otherwise it is paid as a lesser assessment (GP16).
• Same patient, same physician, same diagnosis: one consultation per two consecutive 12-month periods, with a second allowed only for an in-patient or ED consult 12–24 months after the first; a clearly unrelated diagnosis allows one per 12 months. Extra consults are paid as an assessment (GP17, GP18). Time-based consultations count toward these limits.
• Specialist consultations, limited consultations and repeat consultations get an age premium: +30% under 30 days, +25% to 1 year, +20% to 2 years, +15% to 5 years, +10% to 16 years (GP64).
• For a patient 18 or older, a paediatrician is paid only if they saw the patient from the Paediatrics general listings in the 12 months before the 18th birthday, ongoing management of a chronic condition is needed and the patient is under 22, or the MOH gave written prior approval (A168).
• Video only (never telephone) as virtual care (Appendix J, AJ2). For in-patients or long-term care residents, the virtual physician must not be the MRP, no local physician with the expertise is available (documented by the referrer), and the referrer must have assessed the patient in person within 30 days (A69).

Often billed with

• K001 detention, only after 120 minutes of special paediatric consultation time (GP31).

Common rejections

• ARF: The referring provider number is missing. A consultation needs a written request that names the referring physician or nurse practitioner and their billing number (GP16).
• AT2: This code may be billed by video only (Appendix J, AJ2). A virtual claim must carry K300A, not K301A (telephone).
• A4D: Specialists must bill from the Consultations and Visits listing of their own specialty; this code is in the Paediatrics (26) listing (GP9).

Related codes: A260, C265, C662, C667, W260, K001

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), page A173.

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