K130 – Adolescent periodic health visit
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic health visit (including a primary or secondary school examination) is performed on a patient, after their second birthday, who presents and reveals no apparent acute physical or mental illness. The service must include an intermediate assessment, a level 2 paediatric assessment or a partial assessment focusing on age and gender appropriate history, physical examination, health screening and relevant counselling. As per , no diagnostic code is required for this service.
When to Use
- Use K130 for the annual wellness check of a 16 or 17-year-old patient who is asymptomatic and requires age-appropriate screening, such as immunization review or lifestyle counseling.
- Use this code for a school-required physical examination when the patient presents without any acute physical or mental health complaints.
Common Pitfalls
- Billing K130 when the patient presents with an acute issue, such as a sore throat or injury; in these cases, an A007 or A001 is the appropriate code.
- Submitting K130 more than once in a 12-month period, which will trigger an automatic rejection as it exceeds the frequency limit.
- Failing to document the specific age-appropriate screening or counseling performed, which is a mandatory requirement under GP21.
Billing Tips
- Do not include a diagnostic code on the claim, as K130 is explicitly exempt from this requirement under the General Preamble.
- If the patient requires a mental health assessment or counseling during the visit, bill K130 as the primary service and consider adding a time-based counseling code like K013 if the criteria for that code are met separately.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
As per , all assessments must include a direct physical encounter with the patient including taking a patient history and performing a physical examination.
As per , the service must include an intermediate assessment, a level 2 paediatric assessment or a partial assessment focusing on age and gender appropriate history, physical examination, health screening and relevant counselling.
Adolescent
For definitions and payment rules - see General Preamble .
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