K065 – Eye examination for ODSP recipients
OHIP Consultation & Visit Premium Codes Code — PERIODIC OCULO-VISUAL ASSESSMENT · Schedule of Benefits
An eye examination rendered to patients between the ages of 20 and 64 who are recipients of income support under the Ontario Disability Support Program Act, 1997. These assessments are rendered primarily to determine if a patient has a simple refractive error (defined as myopia, hypermetropia, presbyopia, anisometropia or astigmatism) and include all services necessary to perform the assessment: - ordinarily relevant ocular medical history - relevant past medical history - relevant family history - visual acuity examination - ocular mobility examination - refraction - slit lamp examination of the anterior segment - ophthalmoscopy - tonometry - advice and/or instruction to the patient - provision of a written refractive prescription if required.
When to Use
- Use K065 for routine eye examinations for patients aged 20-64 who present with a valid ODSP card to determine refractive error.
- Use this code when the primary purpose of the visit is to provide a refractive prescription for a patient on ODSP, as these services are not covered under the standard Schedule of Benefits.
Common Pitfalls
- Billing any other service code on the same day by the same physician will result in an automatic rejection of the K065 claim.
- Attempting to bill K065 for patients outside the 20-64 age range will result in rejection; patients outside this bracket fall under different coverage rules.
- Submitting K065 for medical eye conditions (e.g., glaucoma management or acute infection) is incorrect; these should be billed using standard assessment codes like A005 or A007.
Billing Tips
- Ensure the patient's ODSP status is active at the time of service, as the Ministry acts only as a paying agent for MCCSS and will reject claims for ineligible recipients.
Effective: April 1, 2026
AF. Appendix F
PERIODIC OCULO-VISUAL ASSESSMENT
Assessment
Assessments
Patients between the ages 20 and 64
This service is not an "insured service" within the meaning of the Health Insurance Act but is 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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