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Billing code

C473A — Respiratory medical specific assessment – hospital in-patient

Respirology in-patient specific assessment

Bill when a respirologist 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 as a lesser assessment.

Code

C473A

Description

Respiratory medical specific 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

Medical specific assessment by a respirologist for a hospital in-patient: full history of the complaint and detailed exam of affected systems.

What it covers

C473 is a medical specific assessment by a specialist in Respiratory Disease for a non-emergency hospital in-patient (A199).

It needs a full history of the presenting complaint and a detailed exam of the affected parts, regions or systems needed to make a diagnosis, exclude disease or assess function (GP23).

Billing rules

• One per patient per physician per 12 months; two if the second has a clearly different, unrelated diagnosis, or is a hospital admission assessment at least 90 days after the last. Excess claims pay as a lesser assessment (GP23).
• Medical specific assessments and complex medical specific re-assessments together are limited to 4 per patient per physician per 12 months (GP23, GP24).
• If you assessed the patient in the ED or out-patient department with a medical specific assessment and then admit them, that assessment is the admission assessment (GP40). If this is your admission assessment and you are the MRP, E082 (+30%) may be added once per admission; not for transfers within the same hospital (GP42).
• 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).

Often billed with

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

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: A473, C474, C471, C570, C472, E082

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Respiratory Disease (47), page A199. Rules GP23, GP40.

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