K057 – Medical Form Part A for Medical Review process
OHIP Consultation & Visit Premium Codes Code — MCSS ONTARIO DISABILITY SUPPORT PROGRAM (ODSP) · Schedule of Benefits
This service code provides payment for completing the 'Medical Form Part A for Medical Review process' for the Ontario Disability Support Program (ODSP). As stated in Appendix F of the Schedule of Benefits, 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 Children, Community and Social Services (MCCSS).
When to Use
- Use K057 specifically when completing the 'Medical Review' form for an existing ODSP recipient, distinct from the initial application form covered by K050.
- Submit K057 when the patient presents specifically for the medical review process documentation, rather than a standard office visit billed under A007 or K030.
Common Pitfalls
- Billing K057 for an initial ODSP application form, which must be billed under K050 instead.
- Attempting to bill an office visit fee (e.g., A007) in addition to K057 for the same encounter, which will result in a rejection for duplicate service.
- Submitting K057 without confirming the patient is undergoing a formal ODSP medical review, as this code is not applicable for general disability-related letters or insurance forms.
Billing Tips
- Ensure the patient's ODSP file number is clearly documented in your clinical notes to support the claim during an audit of non-insured services.
- Since K057 is a Ministry-paid service under Appendix F, ensure your billing software is configured to submit this under the correct MCCSS program code to avoid payment delays.
Effective: April 1, 2026
AF. Appendix F
MCSS ONTARIO DISABILITY SUPPORT PROGRAM (ODSP)
Other
Other Premiums (including After Hours Procedure Premiums)
Completion of the 'Medical Form Part A for Medical Review process' is required.
Appendix F does not form part of the Schedule of Benefits: Physician Services under the Health Insurance Act and is reproduced for your information only.
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