K013 – Individual care
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Individual counselling is counselling rendered to a single patient. Counselling is a patient visit dedicated solely to an educational dialogue with a physician for the purpose of developing awareness of the patient's problems or situation and of modalities for prevention and/or treatment, and to provide advice and information in respect of diagnosis, treatment, health maintenance and prevention. K013 is payable for the first three units of individual counselling (K013) and group counselling (K040) combined, per patient per provider, per 12-month period. Additional units are payable as K033. In addition to the common elements (see , ), all Counselling services include the specific elements listed on .
When to Use
- Use K013 for a dedicated 20+ minute educational dialogue regarding a chronic disease management plan or complex lifestyle modification that is distinct from a standard assessment.
- Use K013 when providing intensive smoking cessation or weight management counseling that exceeds the scope of a routine office visit.
- Use K013 for mental health support sessions where the focus is on developing coping strategies for a specific, diagnosed condition.
Common Pitfalls
- Billing K013 on the same day as an A007 or A001 without documenting two distinct, unrelated diagnoses, which triggers an automatic rejection.
- Failing to record the exact start and end times in the chart, which is a mandatory requirement for all time-based counseling codes.
- Billing K013 for sessions lasting less than 20 minutes, which must be billed as a standard assessment code instead.
Billing Tips
- Ensure the counseling session is pre-booked; walk-in counseling visits are subject to automatic adjustment to a lower assessment fee.
- If you have already billed 3 units of K013 or K040 in the last 12 months, switch to K033 to avoid payment adjustments.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Counselling
Psychotherapy, Psychiatric and Counselling Services
For time-based services, the physician must record on the patient's permanent medical record or chart the time when the insured service started and ended. If this information is not included, the service is not eligible for payment.
Unit means ½ hour or major part thereof - see General Preamble , to for definitions and time-keeping requirements.
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