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Billing code

C481A — Rheumatology complex medical specific re-assessment – hospital in-patient

Rheumatology complex in-patient re-assessment

Bill when a rheumatologist 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 a lesser fee.

Code

C481A

Description

Rheumatology 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 medical specific re-assessment of an in-patient by a rheumatologist, with a written report to the primary care physician.

What it covers

A complex medical specific re-assessment is done because of the complexity, obscurity or seriousness of the condition and includes all requirements of a medical specific re-assessment (GP24).

C481 is the in-patient version of A481 (A205).

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).
• Send a written report to the patient's primary care physician, or it is paid at a lesser fee (GP24).
• Limited to 4 per patient per physician per 12 months, and to 4 combined with medical specific assessments (GP24).
• 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: C484, C483, C480, A481

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Rheumatology (48), Non-emergency hospital in-patient services, page A205.

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