K040 – Group counselling - where no group members have received more than 3 units
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Group Counselling is counselling rendered to two or more patients with a similar medical condition or situation. This service is a patient visit dedicated solely to an educational dialogue with a physician for the purpose of developing awareness of the patient’s problems or situation and of modalities for prevention and/or treatment, and to provide advice and information in respect of diagnosis, treatment, health maintenance and prevention. This specific fee, K040, applies where no group members have received more than 3 units of any counselling paid under codes K013 and K040 combined, per provider, per 12 month period. Unit means ½ hour or major part thereof - see General Preamble , to for definitions and time-keeping requirements.
When to Use
- Use K040 for structured educational sessions with 2 or more patients sharing a common diagnosis, such as a smoking cessation group or a diabetes management workshop.
- Use K040 when the total number of K013 and K040 units for the patient remains at or below the 3-unit threshold for the current 12-month period.
Common Pitfalls
- Billing K040 for a standard office visit where advice is incidental to the assessment, which is specifically prohibited by the General Preamble.
- Failing to maintain the mandatory separate log of all attendees' health numbers, which is a primary target for Ministry of Health audits.
- Submitting the claim under the wrong patient's health number; the claim must be billed to the participant who has the highest cumulative count of K013/K040 units for the year.
Billing Tips
- Ensure the session duration is at least 20 minutes, as services shorter than this do not qualify as counselling and must be billed as a standard assessment.
- Document start and end times precisely in each patient's chart to satisfy the time-based requirements for counselling services.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Counselling
Psychotherapy, Psychiatric and Counselling Services
In addition to meeting the usual medical record requirements, the physician must also maintain a separate record (independent of the patient's medical record) of the names and health numbers of all persons in attendance at each group counselling session.
The physician must record the start and end time of the service in the patient's medical record as per time-based service requirements.
The claim must be submitted under the health number of the group member for whom, when the service was rendered, the largest number of counselling units had previously been claimed by the physician during the year in which the service is rendered.
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