K066 – Eye examination for Ontario Works Act recipients
OHIP Consultation & Visit Premium Codes Code — APPENDIX F · Schedule of Benefits
This service is for an eye examination rendered to patients aged 20 to 64 who are recipients of income assistance or benefits under the Ontario Works Act, 1997. The assessment is primarily to determine if a patient has a simple refractive error (defined as myopia, hypermetropia, presbyopia, anisometropia or astigmatism) and includes all services necessary to perform the assessment. These services ordinarily include: - 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 K066 when performing a routine refraction for an Ontario Works recipient aged 20-64 who does not have an underlying medical eye condition requiring a comprehensive eye exam.
- Use this code specifically for patients presenting for a vision check to obtain a refractive prescription for glasses, provided they meet the Ontario Works eligibility criteria.
Common Pitfalls
- Billing K066 within 24 months of a previous K066 or an optometrist's major oculo-visual examination will result in an automatic rejection.
- Attempting to bill K066 for patients with active ocular pathology that requires a full diagnostic examination is incorrect; these should be billed as standard office assessments (e.g., A007) if the patient is OHIP-insured for medical eye care.
Billing Tips
- Ensure the patient's Ontario Works status is verified at the time of service, as the Ministry acts only as a paying agent for the MCCSS and will reject claims for ineligible patients.
Effective: April 1, 2026
AF. Appendix F
APPENDIX F
Assessment
Assessments
For recipients of income assistance or benefits under the Ontario Works Act, 1997
These services are limited to a maximum of one per patient every 24-month period regardless of whether a periodic oculo-visual assessment or a major eye examination is rendered by the same physician, a different physician, or when the service is rendered by an optometrist described as a “major oculo-visual examination” in the Schedule of Benefits for Optometry Services
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