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K131
K131 – Periodic health visit - adult age 18 to 64 inclusive
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. K131 is specifically for an adult patient aged 18 to 64 inclusive. For full definitions and payment rules, see General Preamble page .
When to Use
- Use K131 for a standard annual physical exam for a patient aged 18 to 64 who presents without acute complaints or new medical concerns.
- Use K131 when performing a school or employment-related physical examination that meets the criteria for a periodic health visit and does not involve an acute illness assessment.
Common Pitfalls
- Billing K131 on the same day as an acute care visit (e.g., A007) will result in a rejection or audit risk, as K131 requires the absence of acute illness.
- Exceeding the limit of one K131 per 12-month period per patient per physician will trigger an automatic rejection.
- Attempting to bill K131 for a patient who presents with a specific acute concern (e.g., sore throat or injury) is inappropriate; use an A007 or K013 instead.
Billing Tips
- Always append the E089 premium when performing a K131 for a cisgender female or a transgender, nonbinary, gender fluid, or agender patient to capture the eligible fee increase.
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