K058 – Medical Form Part B including both Health Status Report and Activities of Daily Living Index for Medical Review process
OHIP Consultation & Visit Premium Codes Code — MCSS ONTARIO DISABILITY SUPPORT PROGRAM (ODSP) · Schedule of Benefits
This service fee is for the completion of the Medical Form Part B, which includes both the Health Status Report and the Activities of Daily Living Index, as part of the Ontario Disability Support Program (ODSP) medical review process. This service is not considered an 'insured service' under the Health Insurance Act but is paid by the Ministry of Health on behalf of the Ministry of Children, Community and Social Services (MCCSS).
When to Use
- Use K058 specifically when completing the full ODSP Medical Review package that requires both the Health Status Report and the Activities of Daily Living (ADL) Index.
- Select K058 instead of K057 when the patient's review necessitates the comprehensive ADL assessment rather than just the Health Status Report.
Common Pitfalls
- Billing K058 in conjunction with an office visit (A007) for the same patient on the same day is often flagged; these forms should be billed as a standalone service.
- Submitting K058 for an initial ODSP application instead of the appropriate initial application code (K054) will result in a rejection.
Billing Tips
- Ensure the claim includes the specific ODSP medical review form reference to justify the higher fee compared to the standalone Health Status Report (K057).
Effective: April 1, 2026
AF. Appendix F
MCSS ONTARIO DISABILITY SUPPORT PROGRAM (ODSP)
Other
Diagnostic and Therapeutic Procedures
Completion of the ODSP Medical Form Part B, which includes both the Health Status Report and the Activities of Daily Living Index.
The services set out in Appendix F are not "insured services" within the meaning of the Health Insurance Act but are paid by the Ministry of Health, acting as paying agent on behalf of the Ministry of Children, Community and Social Services (MCCSS), the Ministry of the Attorney General, the Ministry of the Solicitor General, and the Workplace Safety and Insurance Board (WSIB).
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