A268 – Enhanced 18 month well baby visit
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Enhanced 18 month well baby visit is the service rendered when a physician performs all of the following in respect of a child from 17-24 months of age: a. Those services defined as “well baby care” (periodic assessment, complete examination with weight and measurements, and instructions to parents); b. An 18 month age-appropriate developmental screen; and c. Review with the patient’s parent/guardian, legal representative or other caregiver of a brief standardized tool that aids the identification of children at risk of a developmental disorder.
When to Use
- Bill A268 when a child aged 17-24 months presents for their 18-month well-baby visit, and the physician completes a physical exam, an age-appropriate developmental screen, and reviews a standardized tool like the Nipissing District Developmental Screen with the caregiver.
- Use A268 if the child is within the 17-24 month age range and the physician performs the required developmental screening and tool review, even if the visit also includes routine immunizations (which are payable separately).
- A268 is appropriate when the physician documents the developmental screen and any concerns identified from the standardized tool review in the patient's permanent medical record, fulfilling the documentation requirements.
Common Pitfalls
- Billing A268 for a child outside the 17-24 month age range will result in rejection, as this code is strictly age-bound.
- Attempting to bill A268 with counselling codes (e.g., K005, K007) on the same day is prohibited and will lead to rejection of one of the claims.
- Submitting A268 for virtual care (telephone or video) is not permitted; the visit must be in person to qualify for this code.
Billing Tips
- Ensure all components of the A268 visit are documented, including the physical exam, developmental screen, review of the standardized tool, and any parental counselling or follow-up plans.
- Remember that immunizations administered during the A268 visit are payable in addition to the A268 assessment fee, provided they are billed correctly.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Well Baby Care
Assessment
Complete physical examination including weight and measurements
Instructions to parent/guardian regarding health care
18 month age-appropriate developmental screen (e.g. Rourke Baby Record)
Review of a brief standardized tool (e.g. Nipissing District Developmental Screen) with the caregiver
An 18 month age-appropriate developmental screen and concerns identified from the review of the brief standardized tool with the parent/guardian, legal representative or other caregiver are recorded in the patient’s permanent medical record.
Patient must be from 17-24 months of age.
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