< Billing codes

Billing code

C545A — Gastroenterology in-patient limited consultation

Gastroenterology in-patient limited consultation

Bill for a gastroenterology consultation on a hospital in-patient that takes much less time than a full one but meets all consultation requirements.

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

Code

C545A

Description

Gastroenterology in-patient limited consultation

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 gastroenterology consultation for a hospital in-patient that still meets all consultation requirements.

What it covers

A limited consultation needs substantially less of the physician's time than a full consultation; otherwise the requirements are the same (GP19).

C545 is the in-patient (non-emergency) listing for Gastroenterology (41) (A105).

Billing rules

• Needs a written, signed request from a physician, nurse practitioner or (hospital dental) dental surgeon naming you or the specialty, the referrer and billing number, the patient and health number, and the reason; keep it in the chart or OHIP pays a lesser assessment (GP16).
• Send a written report with findings, opinions and recommendations to the referrer (and to the primary care provider when an NP referred) (GP16).
• Consultation limits apply: one per two consecutive 12-month periods for the same diagnosis (a second only for an in-patient or ED patient 12–24 months later), one per 12 months for an unrelated diagnosis (GP17–GP18).
• If you admit the patient and haven't assessed them for the same illness in the prior 90 days, the admission assessment is billed as the consultation or assessment you provide; only one is payable per admission when care is transferred within the hospital (GP40).
• Under-16 age premiums (10–30%) apply to specialist consultations, limited consultations and repeat consultations (GP64).
• Virtual care by video only (Appendix J AJ2). For an in-patient it is only payable if you are not the MRP, the hospital has no local physician with the expertise (documented by the referrer), and the referrer saw the patient in person within the prior 30 days (A69).

Often billed with

• E082 MRP admission premium when this is your admission assessment as MRP (GP42).

Common rejections

• ARF: OHIP describes this as 'Missing Physician Referring Number': 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 video-only for virtual care, so a telephone (K301A) claim is refused (Appendix J AJ2).

Related codes: C415, C416, C413, A545

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Gastroenterology (41), page A105.

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing