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Billing code

C416A — Gastroenterology in-patient repeat consultation

Gastroenterology in-patient repeat consultation

Bill for another consultation on the same problem for a hospital in-patient after another physician cared for them in between.

Watch for: Needs a new written request with the referrer's billing number; otherwise it pays as an assessment.

Code

C416A

Description

Gastroenterology in-patient repeat 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 repeat gastroenterology consultation for a hospital in-patient, same problem, after another physician has cared for the patient in between.

What it covers

A repeat consultation is an additional consultation by the same consultant for the same presenting problem, after another physician has given care in the interval (GP19).

It needs a new written request, like any consultation. C416 is the in-patient listing for Gastroenterology (41) (A105).

Billing rules

• Needs a new written, signed request kept in the chart (GP16, GP19).
• If the repeat consultation requirements aren't met, OHIP pays an assessment (GP18).
• Repeat consultations don't count toward the consultation limits (GP18).
• Send a written report with findings, opinions and recommendations to the referrer (and to the primary care provider when an NP referred) (GP16).
• 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

• 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: C415, C545, C413, A416

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

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