K026 – Certification of Medical Eligibility for Ohcap
OHIP Consultation & Visit Premium Codes Code — Family Practice & Practice in General (00) · Schedule of Benefits
Certification of Medical Eligibility for OHCAP - 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 and completion of the Application for OHCAP - Physician's Form. When a physician submits a claim for rendering any other consultation or visit on the same day for which the physician submits a claim for Certification of Medical Eligibility for OHCAP, the Certification service is included (in addition to the common elements) as a specific element of the other service.
When to Use
- Use K026 when the primary purpose of the visit is to complete the OHCAP Physician's Form for a patient seeking financial assistance for Hepatitis C treatments.
- Use K026 when the patient encounter is dedicated to the assessment and certification process, provided no other consultation or visit code is billed on the same day.
Common Pitfalls
- Billing K026 on the same day as an A007 or K030 will result in a rejection or a clawback, as the certification is considered an included element of those visits.
- Submitting K026 without ensuring the specific 'Application for OHCAP - Physician's Form' is fully completed and retained in the patient record.
Billing Tips
- If you perform a comprehensive assessment on the same day as the OHCAP certification, bill the appropriate visit code (e.g., A007) instead of K026 to capture the higher value of the visit.
Effective: April 1, 2025
Consultations and Visits
Family Practice & Practice in General (00)
Other
Assessments
Completion of the Application for OHCAP - Physician's Form.
Ontario Hepatitis C Assistance Program (OHCAP)
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