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Billing code

C411A — Gastroenterology in-patient complex medical specific re-assessment

Gastroenterology complex in-patient re-assessment

Bill when a gastroenterologist re-assesses a hospital in-patient because the condition is complex, obscure or serious.

Watch for: Send a written report to the patient's primary care physician, or it pays a lesser fee.

Code

C411A

Description

Gastroenterology in-patient complex medical specific re-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

A gastroenterologist's re-assessment of a hospital in-patient with a complex, obscure or serious condition, with a written report.

What it covers

A complex medical specific re-assessment is a re-assessment because of the complexity, obscurity or seriousness of the condition, with all the requirements of a medical specific re-assessment (GP24).

Findings, opinions or recommendations must go in writing to the patient's primary care physician (GP24). C411 is the in-patient listing (A105).

Billing rules

• Written report to the primary care physician is required, or it pays a lesser fee (GP24).
• Limited to 4 per patient per physician per 12 months (GP24).
• Medical specific assessments and complex medical specific re-assessments combined are limited to 4 per patient per physician per 12 months (GP23–GP24).
• The gastroenterology chronic disease premium (E098) is not payable for in-patients (A104).
• Virtual care by video only (Appendix J AJ2). For an in-patient it is only payable if you are not the MRP, the hospital has no local physician with the expertise (documented by the referrer), and the referrer saw the patient in person within the prior 30 days (A69).

Common rejections

• AT2: OHIP describes this as 'Must Include Video Modality': this code is video-only for virtual care, so a telephone (K301A) claim is refused (Appendix J AJ2).

Related codes: A411, C413, C415, C412

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Gastroenterology (41), page A105.

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