K022 – HIV primary care
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Primary care of patients infected with the Human Immunodeficiency Virus. This service includes any combination of common and specific elements of any insured service listed under “Family Practice & Practice In General” in the “Consultations and Visits" section. In all cases, it includes the same minimum time period requirements described for counselling in the General Preamble (). The service is measured in units, where one unit means ½ hour or the major part thereof. See and for specific time-keeping requirements and unit calculations. When a physician submits a claim for rendering any other consultation or visit to the same patient on the same day, the K022 service is included (in addition to the common elements) as a specific element of the other insured service.
When to Use
- Use K022 for dedicated, time-based primary care management of HIV-positive patients when the visit duration is at least 16 minutes (the major part of a half-hour).
- Use K022 when providing comprehensive HIV-related counseling or complex care planning that exceeds the scope of a standard A007 or A001 assessment.
Common Pitfalls
- Billing K022 on the same day as an A001, A007, or any other consultation/visit code will result in a $0 payment for K022, as it is considered a component of the other service.
- Failure to explicitly document the start and end times in the medical record is the most frequent cause of audit clawbacks for this code.
- Billing K022 for patients who do not have a documented HIV diagnosis in their chart, as this is a specific requirement for this code class.
Billing Tips
- You can claim the E080 premium alongside K022 if the visit occurs within 14 days of discharge from an acute care hospital, provided you are the primary care physician.
- Ensure your documentation clearly reflects the time spent on HIV-specific care to justify the unit count, as K022 is strictly time-dependent.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Assessments, Psychotherapy, Psychiatric and Counselling Services
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.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.