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Billing code

C603A — Medical Specific Assessment

Cardiology in-patient specific assessment

Bill when a cardiologist takes a full history of the complaint and examines the affected systems of a hospital in-patient.

Watch for: One per patient per physician per 12 months, two only for an unrelated diagnosis or later admission; extras pay as a lesser assessment.

Code

C603A

Description

Medical Specific Assessment

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

Medical specific assessment by a cardiologist for a hospital in-patient: full history of the complaint and detailed exam of the affected systems.

What it covers

C603 is a medical specific assessment by a cardiologist for a non-emergency hospital in-patient (A80).

A medical specific assessment is a specialist service, not in the patient's home, that needs a full history of the presenting complaint and a detailed exam of the affected parts, regions or systems needed to make a diagnosis, exclude disease and/or assess function (GP23).

Billing rules

• One per patient per physician per 12 months; two if the second visit has a clearly different, unrelated diagnosis, or is a hospital admission assessment at least 90 days after the last one. Excess claims pay as a lesser assessment (GP23).
• Medical specific assessments and complex medical specific re-assessments together are limited to 4 per patient per physician per 12 months (GP23, GP24).
• If you admit the patient and haven't assessed them for the same illness in the past 90 days, the admission assessment is your consultation or specific assessment; only one consultation or assessment is paid per admission when the patient is transferred to another physician in the same hospital (GP40).
• The congestive heart failure premium (E088) is not payable for in-patients; it applies only to office or hospital out-patient clinic assessments (A79).
• Virtual care: video only, not phone (Appendix J, AJ2). For an in-patient, you must not be the MRP, the hospital must lack a local physician with the expertise (documented by the referrer), and the referrer must have seen the patient in person within 30 days (A69).
• For emergency calls and other special visits to in-patients, bill the A-prefix General Listings with special visit premiums instead (A80, GP65–GP78).

Often billed with

• E082 admission assessment by the MRP (+30%) when this service is your admission assessment as MRP; once per admission, not for transfers within the hospital (GP42).
• C101 ICU/CCU premium for each patient seen on a visit to the ICU or CCU, unless a critical care, ventilatory or comprehensive care team fee is claimed (GP103).

Common rejections

• AT2: OHIP's message is 'Must Include Video Modality': in-patient (C-prefix) virtual services are video only, so a phone claim (K301A) is refused (AJ2).

Related codes: A603, C604, C601, C600, C605, E082

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Cardiology (60), page A80; rules GP23, GP40.

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