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Billing code

C515A — Physical medicine and rehabilitation limited consultation – hospital in-patient

Physiatry in-patient limited consultation

Bill for a physiatry consultation on a hospital in-patient that is less demanding and takes much less time than a full one.

Watch for: Include the referrer's billing number from the signed written request; without it, it pays as a lesser assessment.

Code

C515A

Description

Physical medicine and rehabilitation limited 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

A shorter, less demanding physiatry consultation for a hospital in-patient. Same written-request rules as a full consultation.

What it covers

A limited consultation is less demanding and normally takes substantially less of the physician's time than a full consultation; otherwise it has the same requirements (GP19).

C515 is the Physical Medicine & Rehabilitation (31) limited consultation for a non-emergency hospital in-patient (A178).

Billing rules

• Needs a written, signed request from the referring physician or nurse practitioner naming the patient, the referrer's billing number and the reason; otherwise it is paid as a lesser assessment (GP16).
• Send a written report with findings, opinions and recommendations to the referrer (GP16).
• Same patient, same physician, same diagnosis: one consultation per two consecutive 12-month periods, with a second allowed only for an in-patient or ED consult 12–24 months after the first; a clearly unrelated diagnosis allows one per 12 months. Extra consults are paid as an assessment (GP17, GP18).
• 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).
• Specialist consultations, limited consultations and repeat consultations get an age premium: +30% under 30 days, +25% to 1 year, +20% to 2 years, +15% to 5 years, +10% to 16 years (GP64).
• 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).

Common rejections

• ARF: The referring provider number is missing. A consultation needs a written request that names the referring physician or nurse practitioner and their billing number (GP16).
• AT2: This code may be billed by video only (Appendix J, AJ2). A virtual claim must carry K300A, not K301A (telephone).

Related codes: A515, C315, C316, W310

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

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