K119 – Paediatric developmental screening
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Paediatric Developmental Assessment Incentive (PDAI) is the service rendered by a paediatrician most responsible for providing ongoing management of a paediatric patient at developmental risk. The service is for ongoing management using a developmental surveillance approach and documenting the indicators of the child's development three times in a 12 month period.
When to Use
- Use K119 when you have completed three standardized developmental screenings (e.g., ASQ-3 or Nipissing) for a high-risk child under age six within a rolling 12-month window.
- Bill this code as a standalone incentive when the longitudinal surveillance requirements are met, distinct from standard office visit codes like A005.
Common Pitfalls
- Billing K119 before the third screening is completed in the 12-month period will result in a rejection or clawback during audit.
- Failing to document the specific standardized tool used and the resulting scores in the permanent record makes the claim ineligible for payment.
- Attempting to bill K119 for a patient who has already reached their sixth birthday, as the code is strictly restricted to children under age six.
Billing Tips
- Track the three screening dates in your EMR to ensure the 12-month threshold is met before submission, as the Ministry may request proof of all three assessments during a review.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
K119 is only eligible for payment if a standardized developmental screening tool has been completed three times for the previous 12 month period and is maintained in the patient’s permanent medical record.
Patient must be under six years of age.
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