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Billing code

C313A — Physical medicine and rehabilitation medical specific assessment – hospital in-patient

Physiatry in-patient specific assessment

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

Watch for: One per patient per physician per 12 months, two only for a different diagnosis or later admission; extras pay a lesser fee.

Code

C313A

Description

Physical medicine and rehabilitation medical specific 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

Physiatrist in-patient assessment with a full history of the complaint and a detailed exam of the affected parts or systems.

What it covers

A medical specific assessment is a specialist service with a full history of the presenting complaint and a detailed exam of the affected part(s), region(s) or system(s) needed to make a diagnosis, exclude disease or assess function (GP23).

C313 is the Physical Medicine & Rehabilitation (31) code for a non-emergency hospital in-patient (A178).

Billing rules

• Medical specific assessments are limited to one per patient per physician per 12 months, or two if a clearly different diagnosis is made or (after 90 days) the second is a hospital admission assessment; extras are paid at a lesser fee (GP23).
• Medical specific assessments and complex medical specific re-assessments together are limited to 4 per patient per physician per 12 months (GP23, GP24).
• If you admit a patient you have not seen for the same illness in the past 90 days, the admission assessment is a consultation or medical specific assessment (GP40).
• Non-emergency hospital in-patient service. For emergency calls and other special visits to in-patients, use the General Listings (A prefix) with premiums (A178, GP65–GP78).
• 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 premium (+30%) when this is the MRP's admission assessment; once per admission (GP42).
• K001 detention after 60 minutes (GP30).

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: A313, C311, C315, C312, C511, E082

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Physical Medicine & Rehabilitation (31), page A178.

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