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Billing code

C485A — Rheumatology consultation – hospital in-patient

Rheumatology in-patient consultation

Bill when a rheumatologist consults on a non-emergency hospital in-patient following a signed written request, with a written report back.

Watch for: Include the referring physician's or nurse practitioner's billing number on the claim.

Code

C485A

Description

Rheumatology 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

Rheumatology consultation for a hospital in-patient, following a written request.

What it covers

C485 is the rheumatology consultation for a non-emergency acute hospital in-patient (A205). A consultation is an assessment requested in writing because of the complexity, seriousness or obscurity of the case, or at the patient's request for another opinion (GP16).

It includes a general, specific or medical specific assessment, review of relevant data and a written report to the referrer (GP16).

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).
• Needs a written, signed request naming you or your specialty, the referrer and billing number, and the patient and health number; in hospital it may be on the common medical record (GP16).
• Limited to one per patient per physician for the same diagnosis in two consecutive 12-month periods; a second is allowed for an in-patient or ED consultation 12–24 months after the first (GP17).
• Age premium of 10–30% for patients under 16 (GP64).
• 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

• ARP: OHIP describes this as 'Referring Physician Number Required': a consultation needs the referring physician's or nurse practitioner's billing number (GP16).
• 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: A485, C590, C595, C486, 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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