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Billing code

C415A — Gastroenterology in-patient consultation

Gastroenterology in-patient consultation

Bill when a gastroenterologist 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

C415A

Description

Gastroenterology in-patient consultation

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 full gastroenterology consultation for a hospital in-patient, at the written request of a referring physician or nurse practitioner.

What it covers

C415 is the consultation listing for non-emergency hospital in-patients under Gastroenterology (41) (A105). The consultation rules are the same as in the office: written request, an assessment, and a written report (GP16).

For emergency calls or other special visits to in-patients, use the General Listings (A-prefix) and special visit premiums instead (A105).

Billing rules

• Needs a written, signed request from a physician, nurse practitioner or (hospital dental) dental surgeon naming you or the specialty, the referrer and billing number, the patient and health number, and the reason; keep it in the chart or OHIP pays a lesser assessment (GP16).
• Send a written report with findings, opinions and recommendations to the referrer (and to the primary care provider when an NP referred) (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 12–24 months after the first. Clearly unrelated diagnosis: one per 12 months. Extra consultations pay as an assessment (GP17–GP18).
• 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).
• Detention (K001) may follow only after 60 minutes (GP30).
• Under-16 age premiums (10–30%) apply to specialist consultations, limited consultations and repeat consultations (GP64).
• 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).
• K001 detention after the first 60 minutes (GP30).

Common rejections

• ARF: OHIP describes this as 'Missing Physician Referring Number': a consultation needs the referring physician's or nurse practitioner's billing number (GP16).
• 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: C416, C545, C413, C411, C412, A415, E082

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

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