< Billing codes

Billing code

C395A — Psychiatry limited consultation – hospital in-patient

Psychiatry in-patient limited consultation

Bill for a psychiatric consultation on a hospital in-patient that is less demanding and takes much less time than a full one.

Watch for: Include the referrer's billing number from the signed written request; without it, it pays as a lesser assessment.

Code

C395A

Description

Psychiatry limited 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

Limited psychiatric consultation for a hospital in-patient: a less demanding consultation needing much less time than a full one.

What it covers

C395 is a limited consultation by a psychiatrist for a non-emergency hospital in-patient (A186).

A limited consultation is less demanding and normally takes substantially less of the physician's time than a full consultation; otherwise it has the same requirements as a full consultation (GP19).

Billing rules

• Needs a written, signed request naming you or the specialty, the referrer and their billing number, and the patient and health number, kept in your chart (a common hospital record is fine). Without it OHIP pays a lesser assessment (GP16).
• Same patient, same diagnosis: one consultation per two consecutive 12-month periods; a second is allowed only for an in-patient or ED patient 12 to 24 months after the first. Excess claims pay as an assessment (GP17, GP18).
• If this is your admission assessment and you are the MRP, E082 (+30%) may be added once per admission; not for transfers within the same hospital (GP42).
• For emergency calls and other special visits to in-patients, bill the General Listings (A-prefix) with the special visit premiums instead (A186, GP65–GP78).
• Virtual care: video only, not phone (AJ2). For an in-patient you must not be the MRP, the hospital must lack a local physician with the expertise (documented by the referrer), and for a consultation the referrer must have seen the patient in person within 30 days (A69).

Often billed with

• E082 MRP admission premium when this is the admission assessment (GP42).

Common rejections

• ARF: OHIP's message is 'Missing Physician Referring Number': a consultation needs a written request from a physician or nurse practitioner, and the referrer's billing number must be on the claim (GP16).
• AT2: OHIP's message is 'Must Include Video Modality': this code is on the video-only list, so a phone claim (K301A) is refused (AJ2).

Related codes: A395, W395, C895, C196, C193

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Psychiatry (19), page A186. Rules GP16–GP19.

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