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Billing code

C265A — Paediatric consultation – hospital in-patient

Paediatric in-patient consultation

Bill when a paediatrician consults on a non-emergency hospital in-patient at the written request of a physician or nurse practitioner.

Watch for: Include the referrer's billing number from the signed written request, or it is refused or paid as a lesser assessment.

Code

C265A

Description

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

Consultation by a paediatrician for a hospital in-patient, at the request of a referring physician or nurse practitioner.

What it covers

A consultation is an assessment done at the written request of a physician, nurse practitioner or (for hospital dental procedures) a dental surgeon who wants the opinion of a consultant because of the complexity, seriousness or obscurity of the case, or because the patient asked for another opinion (GP16).

C265 is the Paediatrics (26) consultation for a non-emergency hospital in-patient (A173). The office or general listing equivalent is A265 (A168).

Billing rules

• 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).
• Send a written report with findings, opinions and recommendations to the referrer (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).
• 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).
• If you first saw the patient in the ED or out-patient department with a consultation and then admit them, that consultation is the admission assessment (GP40).
• 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

• E082 MRP admission assessment premium (+30%) when the consultation is the MRP's admission assessment (GP40, GP42).
• K001 detention after 60 minutes of consultation time (GP30).

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: A265, C260, C662, C667, C565, C266, C263, W265

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

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