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Billing code

C489A — Rheumatology subsequent hospital visit – after week 13

Rheumatology hospital visit, week 14+

Bill for a rheumatologist's routine hospital visit after the 13th week of admission.

Watch for: Maximum 6 per patient per month; bill an extra visit for an acute intercurrent illness as C121 instead.

Code

C489A

Description

Rheumatology subsequent hospital visit – after week 13

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

Rheumatologist's routine in-patient visit after the thirteenth week of admission, maximum 6 per month.

What it covers

C489 is a routine hospital subsequent visit by a rheumatologist after the admission assessment (A205, GP43).

Visits are coded by how long since admission: first five weeks, sixth to thirteenth week, or after the thirteenth week (GP43).

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).
• A subsequent visit is any routine hospital assessment after the admission assessment (GP43).
• Maximum 6 per patient per month after week 13; visits over the limit aren't payable (A205, GP43).
• When a patient is referred to you in hospital, the date you first assess them counts as the admission date for choosing the code; after a transfer of care, count from the actual admission date (GP43).
• After 5 weeks, visits for an acute intercurrent illness beyond the limits are billed as C121 (GP43).
• The MRP may add E083 (+30%) to subsequent visits, or E084 (+45%) on Saturdays, Sundays and holidays; not both on the same day (GP47).
• Not on the Appendix J virtual care list (Appendix J).

Often billed with

• E083 MRP subsequent visit premium (GP47). E084 on weekends and holidays (GP47).

Common rejections

• AM1: OHIP describes this as 'Service Limit Exceeded': more subsequent visits than the weekly or monthly limit for this stage of the admission (GP43).
• AT4: OHIP describes this as 'Modality Not Allowed': hospital subsequent and concurrent care visits aren't on the Appendix J virtual care list, so they can't carry K300A or K301A (Appendix J).

Related codes: C482, C487, C488, C121, E083

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

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