K003 – Interviews with Children’s Aid Society (CAS) or legal guardian
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Interviews with Children's Aid Society (CAS) or legal guardian on behalf of the patient in accordance with the Health Care Consent Act conducted for a purpose other than to obtain consent. Interviews are not eligible for payment when the information being obtained is part of the history normally included in the consultation or assessment of the patient. The interview must be a booked, separate appointment lasting at least 20 minutes. This listing applies to situations where medically necessary information cannot be obtained from or given to the patient or guardian, e.g. because of illness, incompetence, etc. The service is claimed using the patient's health number and diagnosis.
When to Use
- Use K003 when you must conduct a dedicated 20-minute discussion with a CAS worker regarding a patient's care plan that falls outside the scope of a standard history-taking session.
- Use K003 for complex care coordination with a legal guardian when the patient is unable to participate due to cognitive impairment or acute illness, provided the discussion is not part of a routine assessment.
Common Pitfalls
- Billing K003 for information gathering that should have been captured during a standard consultation or assessment, which will lead to audit recovery.
- Failing to document the exact start and end times of the interview, which is a mandatory requirement for this code and a frequent cause of rejection.
- Claiming K003 for brief phone calls or unscheduled interactions, as the code strictly requires a booked, separate appointment of at least 20 minutes.
Billing Tips
- Ensure your chart note explicitly states why the information could not be obtained from the patient directly, referencing the specific medical necessity or incapacity.
- You may bill K003 on the same day as K013 or K033, provided the K003 service is distinct and meets the 20-minute minimum duration requirement.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Interviews
Claimed using the patient's health number and diagnosis.
The physician must record on the patient's permanent medical record or chart the time when the insured service started and ended.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.