Billing code
C480A — Complex rheumatology assessment – hospital in-patient
Complex rheumatology in-patient assessment
Bill for ongoing rheumatologist management of an in-patient with vasculitis, inflammatory myopathy or polymyalgia rheumatica.
Watch for: Not for your first evaluation of the patient; limited to 6 per patient per physician per 12 months.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $112.00 | $0.00 | $0.00 | $0.00 |
- Code
- C480A
- Description
- Complex rheumatology 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 rheumatology assessment of an in-patient with vasculitis, inflammatory myopathy or polymyalgia rheumatica; same conditions as A480.
What it covers
C480 is the in-patient complex rheumatology assessment, subject to the same conditions as A480 (A205).
A480 is for ongoing management of systemic vasculitides, inflammatory myopathies, polymyalgia rheumatica or paediatric vasculitides where the condition needs continuing rheumatologist management (A200).
Billing rules
- C-prefix codes are for non-emergency services to acute hospital in-patients; emergency calls and special visits to in-patients use the A-prefix General Listings with premiums (A205, GP12).
- Must include the elements of a medical specific re-assessment, or it is paid at a lesser fee (A200).
- Not for your initial evaluation of the patient (A200).
- Limited to 6 per patient per physician per 12 months (A200).
- Detention (K001) may start after 60 minutes (GP30).
- By video only, and for in-patients only when you aren't the MRP, no local physician with the expertise is available, and the referrer assessed the patient in person within the prior 30 days (Appendix J, A66).
Common rejections
- AT2: OHIP describes this as 'Must Include Video Modality': this code is on the video-only virtual care list, so it can't be billed by telephone (K301A) (Appendix J).
Related codes: A480, C484, C481, C483
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Rheumatology (48), Non-emergency hospital in-patient services, page A205.
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