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Billing code

C475A — Respiratory disease consultation – hospital in-patient

Respirology in-patient consultation

Bill when a respirologist consults on a non-emergency hospital in-patient after a written request, sending a written report back.

Watch for: Include the referrer's billing number from the signed written request, or it is refused or paid as a lesser assessment.

Code

C475A

Description

Respiratory disease consultation – 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

Consultation by a respirologist for a hospital in-patient, after a written request, with a written report back.

What it covers

C475 is a consultation by a specialist in Respiratory Disease for a non-emergency hospital in-patient (A199).

A consultation is an assessment requested in writing because of the complexity, seriousness or obscurity of the case, or because another opinion is requested, with a written report to the referrer (GP16).

Billing rules

• Needs a written, signed request naming you or the specialty, the referrer and their billing number, and the patient and health number, kept in your chart (a common hospital record is fine). Without it OHIP pays a lesser assessment (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 to 24 months after the first. Excess claims pay as an assessment (GP17, GP18).
• A consultation by the admitting specialist can be 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).
• For emergency calls and other special visits to in-patients, bill the General Listings (A-prefix) with the special visit premiums instead (A199, GP65–GP78).
• 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

• ARF: OHIP's message is 'Missing Physician Referring Number': a consultation needs a written request from a physician or nurse practitioner, and the referrer's billing number must be on the claim (GP16).
• 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: A475, C470, C575, C476, C473, E082

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Respiratory Disease (47), page A199. Rules GP16–GP19, GP40.

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