K012 – Group psychotherapy - 4 people
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Psychotherapy is any form of treatment for mental illness, behavioural maladaptations, and/or other problems that are assumed to be of an emotional nature, where a physician deliberately establishes a professional relationship with a patient with the purpose of removing, modifying or retarding existing symptoms, or attenuating or reversing disturbed patterns of behaviour, and of promoting positive personality growth and development. This service is for group psychotherapy involving 4 people, billed per member, for the first 12 units per day. It is a time-based service where one unit represents ½ hour or a major part thereof.
When to Use
- Use K012 when conducting a structured psychotherapy session with exactly 4 patients present, where each patient is billed individually for the time spent.
- Choose K012 over individual psychotherapy codes like K007 when the clinical objective is specifically group-based interaction and the group size is exactly 4.
Common Pitfalls
- Billing K012 for a group size other than 4; the code is specific to a 4-person group and cannot be used for groups of 3 or 5.
- Failing to document the exact start and end times for each patient in their individual charts, which is a mandatory requirement for all time-based psychotherapy codes.
- Attempting to bill a consultation or assessment on the same day as K012 without distinct, unrelated diagnoses, which will trigger an automatic rejection.
Billing Tips
- Ensure the total time billed per patient reflects the actual duration of the group session; one unit equals 30 minutes or a major part thereof (at least 16 minutes).
- If you qualify for the Focused Practice Psychotherapy Premium, ensure your billing software is configured to automatically append the 17% increase to K012 to maximize your return.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Psychotherapy
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.
Psychotherapy outside hospital and hypnotherapy may not be claimed as such when provided in conjunction with a consultation or other assessments rendered by a physician during the same patient visit unless there are clearly defined different diagnoses for the two services.
Unit means ½ hour or major part thereof - see General Preamble , to for definitions and time-keeping requirements.
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