Error code
C4 — Consultation not allowed with this service - paid as an assessment
Consultation paid as assessment
The consultation was paid at an assessment fee because it isn't allowed with another service already billed for this patient.
What to do: Find the other service it conflicts with and check the Schedule notes for both codes.
- Code
- C4
- Description
- Consultation not allowed with this service - paid as an assessment
Explanation
Updated October 26, 2026
OHIP paid this consultation as an assessment because a consultation isn't payable with another service billed for the patient.
What it means
Code C4 means the consultation was paid at an assessment fee because a consultation isn't allowed with another service already billed for this patient.
The Ministry doesn't say which pairing caused it. The Schedule has examples: a physician who routinely receives an obstetrician's newborns can't claim a consultation for them, and a postnatal consultation of the baby (C265) isn't payable with attendance at the maternal delivery (H267) (K3). More generally, a consultation that doesn't meet all its requirements is paid at a lesser assessment fee (GP16).
Common causes
- A consultation billed with a service that already covers the same care
- A consultation for a patient transferred routinely rather than referred
- A referral that doesn't meet the written-request requirements
How to fix it
- Find the other service billed for the patient that the consultation conflicts with.
- Check the Schedule notes for both codes.
- If the consultation was separately requested and met all its requirements, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date, with supporting details such as your chart notes.
- Otherwise, the assessment payment stands.
Don't resubmit if
- The claim is already on the RA and you only disagree with the decision. Use an RAI, not a new claim.
How APEX handles it
APEX reads your error reports and remittance advice from MCEDT and lists claims rejected with this code in its Correction Centre for you to correct and resubmit. See how APEX works · Pricing