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K035
K035 – Mandatory Reporting of Medical Condition to the Ontario Ministry of Transportation
OHIP Consultation & Visit Premium Codes Code — Family Practice & Practice in General (00) · Schedule of Benefits
Mandatory reporting of medical condition to the Ontario Ministry of Transportation (MTO) requires providing to MTO information that satisfies the requirements of the Highway Traffic Act or any applicable regulations, and includes providing any additional information to MTO regarding a previous report related to the same medical condition.
When to Use
- Use K035 when you are legally obligated under the Highway Traffic Act to report a patient's medical condition to the MTO, such as a new diagnosis of epilepsy or a significant visual impairment.
- Use this code when providing supplemental information requested by the MTO regarding a previously submitted report for the same patient.
Common Pitfalls
- Do not bill K035 for routine driver's medical examinations; those are uninsured services and should be billed directly to the patient, not OHIP.
- Avoid billing K035 for general correspondence or letters to the MTO that do not meet the specific mandatory reporting criteria defined in the Highway Traffic Act.
- Submitting more than one K035 per 12-month period without the manual review indicator will result in an automatic rejection.
Billing Tips
- K035 can be billed on the same day as a counselling code (e.g., K013 or K033) if the patient is seen for both the mandatory reporting process and a separate counselling session.
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