K033 – Individual care - additional units
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A time-based service for individual counselling provided to a single patient. This code is specifically for 'additional units' claimed after the initial three units of combined individual (K013) and group (K040) counselling have been paid for a patient by the same provider in a 12-month period. As defined on :, counselling is a visit dedicated solely to an educational dialogue with a physician to develop awareness of the patient's problems, treatment modalities, and to provide advice on diagnosis, treatment, and prevention. Each unit represents a half-hour or major part thereof, with specific minimum time requirements (e.g., 20 minutes for 1 unit) as detailed on :.
When to Use
- Use K033 only after you have already billed 3 units of K013 or K040 for the same patient within the rolling 12-month period.
- Use this code for extended individual counselling sessions that exceed the annual threshold of 3 units of K013.
- Use this code when providing ongoing, time-intensive educational dialogue for chronic disease management or complex psychosocial issues after the initial K013 limit is exhausted.
Common Pitfalls
- Billing K033 before the 3-unit limit of K013 is reached will result in a rejection or an automatic adjustment to the lower fee.
- Failing to document exact start and end times in the chart is a primary cause for clawbacks during OHIP audits.
- Billing a standard office visit (A007) on the same day as K033 is prohibited; only specific codes listed in GP58 are permitted concurrently.
Billing Tips
- Ensure your EMR tracks the cumulative count of K013 and K040 units per patient to trigger the switch to K033 automatically.
- Always confirm the session duration meets the minimum 20-minute threshold for a single unit, as services under 20 minutes are not eligible for K033.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Counselling
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.
Unit means ½ hour or major part thereof - see General Preamble :, : to : for definitions and time-keeping requirements.
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