< Billing codes

Billing code

C471A — Respiratory complex medical specific re-assessment – hospital in-patient

Respirology complex in-patient re-assessment

Bill when a respirologist 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 as a lesser assessment.

Code

C471A

Description

Respiratory complex medical specific re-assessment – 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

Complex re-assessment by a respirologist for an in-patient with a complex, obscure or serious condition; written report to the primary care doctor.

What it covers

C471 is a complex medical specific re-assessment by a specialist in Respiratory Disease for a non-emergency hospital in-patient (A199).

Re-assessment because of the complexity, obscurity or seriousness of the condition, with all the elements of a medical specific re-assessment. You must send your findings, opinion or recommendations in writing to the patient's primary care physician, or it pays as a lesser assessment (GP24).

Billing rules

• Limited to 4 per patient per physician per 12 months; excess claims pay as a lesser assessment (GP24).
• Medical specific assessments and complex medical specific re-assessments together are limited to 4 per patient per physician per 12 months (GP23, GP24).
• The chronic disease premium E078 is not payable for hospital in-patients (GP25).
• 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).

Common rejections

• 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: A471, C474, C473, C570, C472

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Respiratory Disease (47), page A199. Rule GP24.

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