What are the billing rules for C865A?

Needs a written, signed request from a physician or nurse practitioner that names you or your specialty, the referrer and their billing number, and the patient's health number; otherwise it is paid as a lesser assessment (GP16). Same patient, same diagnosis: one consultation per two consecutive 12-month periods (a second only for a hospital in-patient or ED patient 12–24 months after the first); a clearly unrelated diagnosis allows one per 12 months. Excess claims are paid as an assessment (GP17–GP18). Age premiums apply for patients under 16, from +10% to +30% depending on age (GP64).

Why is C865A rejected?

ARF: The claim has no referring provider number. A consultation must follow a written referral that identifies the referring physician or nurse practitioner and their billing number (GP16). AT2: Billed by telephone (K301A). This code is on Appendix J's video-only list, so it must be done by video and claimed with K300A (AJ2).

< Billing codes

Billing code

C865A — Nephrology limited consultation – hospital in-patient

Q: What is OHIP billing code C865A?

Limited nephrology consultation for a hospital in-patient: a less demanding referral taking substantially less time than a full consultation.

Nephrology in-patient limited consultation

Bill for a nephrology 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.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$116.75	$0.00	$0.00	$0.00

Code: C865A
Description: Nephrology 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

Limited nephrology consultation for a hospital in-patient: a less demanding referral taking substantially less time than a full consultation.

What it covers

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

C865 is the non-emergency hospital in-patient version; the full in-patient consultation is C165 (A137).

Billing rules

Needs a written, signed request from a physician or nurse practitioner that names you or your specialty, the referrer and their billing number, and the patient's health number; otherwise it is paid as a lesser assessment (GP16).
Same patient, same diagnosis: one consultation per two consecutive 12-month periods (a second only for a hospital in-patient or ED patient 12–24 months after the first); a clearly unrelated diagnosis allows one per 12 months. Excess claims are paid as an assessment (GP17–GP18).
Age premiums apply for patients under 16, from +10% to +30% depending on age (GP64).
Seeing patients in the ED or out-patient department while not on ED duty uses the A-prefix General Listings, not C-codes (A130, A137).
By video only, and for in-patients or LTC residents only when you are not the MRP, no local physician with the expertise is available (documented by the referrer), and the referrer saw the patient in person within the prior 30 days (AJ2, A69).

Common rejections

ARF: The claim has no referring provider number. A consultation must follow a written referral that identifies the referring physician or nurse practitioner and their billing number (GP16).
AT2: Billed by telephone (K301A). This code is on Appendix J's video-only list, so it must be done by video and claimed with K300A (AJ2).

Related codes: C165, C166, A865, C163, C160

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Nephrology (16), page A137; rules GP16–GP19.

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