K037 – Fibromyalgia/myalgic encephalomyelitis care
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Fibromyalgia/myalgic encephalomyelitis care is the provision of care to patients with fibromyalgia or myalgic encephalomyelitis. The service includes the common and specific elements of all insured services listed under “Family Practice & Practice In General” in the "Consultations and Visits" section of the Schedule. See General Preamble and for definitions and time-keeping requirements.
When to Use
- Use K037 for a dedicated, time-based counseling or management session specifically addressing the complex, multi-system symptoms of a patient with a confirmed diagnosis of fibromyalgia or myalgic encephalomyelitis.
- Select K037 instead of a standard A007 intermediate assessment when the clinical encounter requires a minimum of 20 minutes of face-to-face time to manage the patient's condition.
Common Pitfalls
- Billing K037 on the same day as any other assessment or visit code (e.g., A007, K030) will result in an automatic rejection, as K037 is an all-inclusive daily service.
- Failure to document exact start and stop times in the medical record is a primary cause for audit recovery, as K037 is strictly a time-based code requiring a minimum of 20 minutes.
Billing Tips
- Ensure the clinical note explicitly links the time spent to the management of fibromyalgia or myalgic encephalomyelitis to justify the use of this specific code over general counseling codes like K013.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Assessments, Psychotherapy, Psychiatric and Counselling Services
As a time-based service, the start and stop times must be recorded in the patient's permanent medical record.
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