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Billing code

C511A — Complex physiatry assessment – hospital in-patient

Complex physiatry in-patient assessment

Bill for a physiatrist's ongoing management of an in-patient with complex traumatic brain injury, stroke or spinal cord injury.

Watch for: Must include a full medical specific re-assessment; limited to 6 per patient per physician per 12 months.

Code

C511A

Description

Complex physiatry 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

In-patient physiatrist assessment for complex traumatic brain injury, stroke or spinal cord injury. Same conditions as A511.

What it covers

A complex physiatry assessment is for traumatic brain injury, stroke (haemorrhagic or ischaemic) or spinal cord injury where the complexity needs ongoing management by a physiatrist (A176). It is not meant for uncomplicated disorders such as TIA, uncomplicated concussion or ASIA level E spinal cord injury (A177).

C511 is the hospital in-patient version and is subject to the same conditions as A511 (A178).

Billing rules

• Must include the elements of a medical specific re-assessment, or it is paid at a lesser fee (A176).
• Limited to 6 per patient per physician per 12 months; extras are paid at a lesser fee (A176).
• E078 is not payable with it (A176).
• Non-emergency hospital in-patient service. For emergency calls and other special visits to in-patients, use the General Listings (A prefix) with premiums (A178, GP65–GP78).
• Video only (never telephone) as virtual care (Appendix J, AJ2). For in-patients or long-term care residents, the virtual physician must not be the MRP, no local physician with the expertise is available (documented by the referrer), and the referrer must have assessed the patient in person within 30 days (A69).

Often billed with

• K001 detention after 60 minutes of complex physiatry assessment time (GP30).

Common rejections

• AT2: This code may be billed by video only (Appendix J, AJ2). A virtual claim must carry K300A, not K301A (telephone).

Related codes: A511, W511, C510, C311, C312

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Physical Medicine & Rehabilitation (31), page A178.

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