K053 – A Limitation to Participation Form
OHIP Consultation & Visit Premium Codes Code — APPENDIX F · Schedule of Benefits
K053 is the fee for completing the MCSS Ontario Works Program (OW) 'A Limitation to Participation Form'. Note: The MCSS forms are provided to patients exclusively by social services staff. This fee code is specific to this form and cannot be used for any other government document. Forms 4, 5, and the Request for Supplementary Information are obsolete. This payment is considered full payment for the service, and no extra charges may be made to OHIP or the patient. For inquiries, contact the local MCSS office.
When to Use
- Use K053 exclusively when completing the specific 'A Limitation to Participation' form provided to an Ontario Works recipient by their caseworker.
- Use this code when the patient presents the official MCSS documentation requiring physician certification of a medical limitation to their participation in work-related activities.
Common Pitfalls
- Claiming K053 on the same day as any other service code will result in an automatic rejection, as it is a standalone fee.
- Billing K053 for other government forms or disability certificates (such as CPP-D or DTC) is a billing error and will lead to recovery during an audit.
- Attempting to bill an additional office visit fee (like A007) alongside K053 is prohibited, as the $17.45 fee is considered full payment for the encounter.
Billing Tips
- Ensure the patient has provided the official MCSS-issued form, as K053 is strictly tied to this specific document and not generic medical notes.
Effective: April 1, 2026
AF. Appendix F
APPENDIX F
Other
Diagnostic and Therapeutic Procedures
The MCSS forms identified above are provided to patients only by social services staff. The fee codes are specific to the applicable form and are not to be claimed for completion of any other government document. Form 4, Form 5 and Request for Supplementary Information are obsolete and will not be accepted by MCSS. Inquiries regarding MCSS forms may be directed to the local MCSS office.
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