K005 – Individual care
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Primary mental health care is a service for individual patients encompassing any combination or form of assessment and treatment by a physician for mental illness, behavioural maladaptations, and/or other problems that are assumed to be of an emotional nature, where there is consideration of the patient's biological and psychosocial functioning. In addition to the common elements, this service includes the specific elements for Psychotherapy, Psychiatric and Counselling Services as outlined in of the Schedule of Benefits. This service is calculated in time units of ½ hour or major part thereof. See the time-keeping requirements in , , and . Note: K005 is not to be billed in conjunction with other consultations and visits rendered by a physician during the same patient visit unless there are clearly different diagnoses for the two services.
When to Use
- Use K005 for individual psychotherapy sessions lasting at least 16 minutes, which constitutes the 'major part' of a 30-minute unit.
- Use K005 when providing structured cognitive-behavioural or supportive counseling for a diagnosed mental health condition that exceeds the scope of a standard A007 assessment.
- Use K005 for follow-up mental health management where the primary focus of the encounter is the therapeutic interaction rather than a physical examination or general medical management.
Common Pitfalls
- Billing K005 on the same day as an A007 or other visit code without distinct, separate diagnoses, which triggers automatic rejection or audit recovery.
- Failing to document the exact start and end times in the medical record, which is a mandatory requirement under GP7 and grounds for full clawback during an audit.
- Billing multiple units of K005 without documenting the total cumulative time spent, as each unit requires 30 minutes or the 'major part' thereof.
Billing Tips
- Ensure your chart note explicitly states the start and end time of the psychotherapy session to satisfy the strict documentation requirements of GP7.
- If you must bill a physical visit (e.g., A007) and K005 on the same day, ensure the diagnostic codes are distinct and clearly support two separate clinical encounters.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Psychotherapy, Psychiatric and Counselling Services
The physician must record on the patient's permanent medical record or chart the time when the insured service started and ended. If the patient's permanent medical record or chart does not include this required information, the service is not eligible for payment.
Unit means ½ hour or major part thereof - see , to for definitions and time-keeping requirements.
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