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Billing code

C264A — Paediatric medical specific re-assessment – hospital in-patient

Paediatric in-patient re-assessment

Bill when a paediatrician re-assesses a non-emergency hospital in-patient with a full relevant history and exam of one or more systems.

Watch for: Limited to 2 per patient per physician in 12 months; routine follow-ups are subsequent visits (C262), not re-assessments.

Code

C264A

Description

Paediatric medical specific re-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

Follow-up re-assessment of a hospital in-patient by a paediatrician, with a full relevant history and exam of one or more systems.

What it covers

A medical specific re-assessment is a specialist service that requires a full, relevant history and physical examination of one or more systems (GP23).

C264 is the Paediatrics (26) code for a non-emergency hospital in-patient (A173); the office equivalent is A264.

Billing rules

• Limited to two per patient per physician per 12 months, except re-assessments done for hospital admissions; extras are paid at a lesser fee (GP23).
• An admission assessment counts as a medical specific re-assessment when you saw the patient for the same illness within 90 days before admitting (GP23, GP40).
• Routine visits after the admission assessment are subsequent visits (C262), not re-assessments (GP43).
• Non-emergency hospital in-patient service. For emergency calls and other special visits to in-patients, use the General Listings (A prefix) with premiums (A173, GP65–GP78).
• 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).

Common rejections

• AT2: This code may be billed by video only (Appendix J, AJ2). A virtual claim must carry K300A, not K301A (telephone).

Related codes: A264, C263, C661, C262, C265

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

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