K054 – Mandatory Special Necessities Benefit Request Form
OHIP Consultation & Visit Premium Codes Code — MCSS ONTARIO DISABILITY SUPPORT PROGRAM (ODSP) · Schedule of Benefits
The service is for the completion of the Mandatory Special Necessities Benefit Request Form. As per , this service is not 'insured' under the Health Insurance Act but is paid by the Ministry of Health, acting as a paying agent on behalf of the Ministry of Community and Social Services (MCSS) for the Ontario Disability Support Program (ODSP).
When to Use
- Use K054 specifically when completing the Mandatory Special Necessities Benefit Request Form for an ODSP recipient to justify items like medical supplies or specialized equipment.
- Use this code when the patient requires a formal request for benefits that fall outside the standard ODSP drug and dental coverage, distinct from the initial Disability Determination Package (K050).
Common Pitfalls
- Billing K054 for general administrative letters or notes that do not utilize the specific Mandatory Special Necessities form will result in rejection.
- Attempting to bill K054 in conjunction with a standard office visit (A007) is often flagged if the documentation does not clearly delineate the time spent on the form versus the clinical assessment.
Billing Tips
- Ensure the patient's ODSP recipient ID is accurately recorded in your billing software, as this is the primary identifier used by the Ministry to process these non-insured service payments.
Effective: April 1, 2026
AF. Appendix F
MCSS ONTARIO DISABILITY SUPPORT PROGRAM (ODSP)
Other
Diagnostic and Therapeutic Procedures
Completion of the Mandatory Special Necessities Benefit Request Form.
This service is not an 'insured service' under the Health Insurance Act. It is paid by the Ministry of Health on behalf of the Ministry of Community and Social Services (MCSS).
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