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Billing code

C263A — Paediatric in-patient medical specific assessment

Paediatric in-patient specific assessment

Bill when a paediatrician takes a full history of the complaint and examines the affected systems of a hospital in-patient.

Watch for: One per patient per physician per 12 months, two only for an unrelated diagnosis or later admission; extras pay as a lesser assessment.

Code

C263A

Description

Paediatric in-patient medical 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

Medical specific assessment of a hospital in-patient by a paediatrician: full history of the complaint and detailed exam.

What it covers

A medical specific assessment is a specialist service, outside the home, that needs a full history of the presenting complaint and a detailed exam of the affected part(s), region(s) or system(s) (GP23). C263 is the Paediatrics in-patient listing (A173).

It can be added to attendance at maternal delivery (H267) when the newborn is sick (A174, K3).

Billing rules

• Limit: one per patient per physician per 12 months, or two if the second is for a clearly unrelated diagnosis or is a hospital admission assessment at least 90 days after the last (GP23).
• Medical specific assessments plus complex medical specific re-assessments are limited to 4 per patient per physician per 12 months combined (GP23).
• Excess pays as a lesser assessment (GP23).
• With H267, payable only when the newborn is sick (A174).
• Paediatric subsequent visits (C262) are limited to one per day for the whole admission (GP43).
• 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

• H267 attendance at maternal delivery, sick newborn (A174).
• E082 admission assessment by the MRP (+30%) when it is your admission assessment as MRP (GP42).

Related codes: A263, C264, C661, C265, C262, H267

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

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