K030 – Diabetic Management Assessment
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Diabetic management assessment (DMA) is an all-inclusive service payable to the most responsible physician for providing continuing management and support of a diabetic patient. The service must include one of the following:
- An intermediate assessment (`A007)
- A level 2 paediatric assessment (A262`)
- A partial assessment
The assessment must focus on diabetic target organ systems, include relevant counselling, and require maintenance of a diabetic flow sheet retained on the patient's permanent medical record. The flow sheet must track lipids, cholesterol, Hgb A1C, urinalysis, blood pressure, fundal examination, peripheral vascular examination, weight and body mass index (BMI), and medication dosage.
When to Use
- Use K030 when performing a comprehensive quarterly review for a diabetic patient that includes the mandatory flow sheet updates, as it pays better than a standard A007.
- Use K030 instead of A007 when you have specifically scheduled a visit to address the required diabetic target organ systems and update the longitudinal flow sheet.
Common Pitfalls
- Billing K030 on the same day as any other assessment code (e.g., A007, K035) will result in the K030 being paid at nil.
- Failing to document all required flow sheet elements—specifically the fundal exam and peripheral vascular exam—is a common trigger for clawbacks during OHIP audits.
- Exceeding the limit of 4 claims per 12-month period per patient will result in automatic rejection of the fifth claim.
Billing Tips
- Always append the E080 premium to K030 if the visit occurs within 14 days of an acute care hospital discharge to maximize the encounter value.
- Ensure your EMR template for K030 automatically populates the required flow sheet fields to guarantee compliance with the documentation requirements listed in the Schedule of Benefits.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
A diabetic flow sheet must be maintained and retained on the patient's permanent medical record.
The flow sheet must track lipids, cholesterol, Hgb A1C, urinalysis, blood pressure, fundal examination, peripheral vascular examination, weight and body mass index (BMI) and medication dosage.
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