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Billing code

C413A — Gastroenterology in-patient medical specific assessment

Gastroenterology in-patient specific assessment

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

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

Code

C413A

Description

Gastroenterology in-patient medical specific 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 full assessment of a hospital in-patient's presenting complaint with a detailed exam of the affected systems.

What it covers

A medical specific assessment needs a full history of the presenting complaint and a detailed exam of the affected part(s), region(s) or system(s) (GP23).

C413 is the non-emergency in-patient listing for Gastroenterology (41), often the admission assessment (A105, GP40).

Billing rules

• Medical specific assessments: one per patient per physician per 12 months, or two if a clearly different, unrelated diagnosis is made or the second is a hospital admission assessment at least 90 days after the last. Extras pay a lesser fee (GP23).
• Medical specific assessments and complex medical specific re-assessments combined are limited to 4 per patient per physician per 12 months (GP23–GP24).
• If you admit the patient and haven't assessed them for the same illness in the prior 90 days, the admission assessment is billed as the consultation or assessment you provide; only one is payable per admission when care is transferred within the hospital (GP40).
• E082 adds 30% to the admission assessment when the admitting physician is the MRP; once per admission, not for transfers within the same hospital (GP42).
• 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).

Often billed with

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

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: A413, C411, C415, C412, E082

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

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