Billing code
C474A — Respiratory medical specific re-assessment – hospital in-patient
Respirology in-patient re-assessment
Bill when a respirologist re-assesses a hospital in-patient with a full relevant history and exam of one or more systems.
Watch for: Limited to 2 per patient per physician in 12 months; routine follow-ups are subsequent visits (C472, C477, C479).
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $72.80 | $0.00 | $0.00 | $0.00 |
- Code
- C474A
- Description
- Respiratory 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
Medical specific re-assessment by a respirologist for a hospital in-patient: full relevant history and exam of one or more systems.
What it covers
C474 is a medical specific re-assessment by a specialist in Respiratory Disease for a non-emergency hospital in-patient (A199).
It needs a full, relevant history and physical exam of one or more systems (GP23).
Billing rules
- Limited to two per patient per physician per 12 months, except when rendered for a hospital admission. Excess claims pay as a lesser assessment (GP23).
- An admission assessment is a medical specific re-assessment when you assessed the patient and then admitted them for the same illness (GP23 commentary), or saw them for the same illness within 90 days (GP40).
- Routine visits after the admission assessment are subsequent visits (C472, C477, C479) (GP43).
- 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: A474, C473, C471, C472, E082
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Respiratory Disease (47), page A199. Rules GP23, GP40.
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