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K132
K132 – Periodic health visit - adult 65 years of age and older
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic health visit 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. Payment is limited to one per patient per 12 month period per physician. Periodic health visits in excess of the limit are not insured. No diagnostic code is required.
When to Use
- Use K132 for an asymptomatic patient aged 65+ presenting specifically for an annual physical examination and health screening.
- Use K132 when the encounter focuses on age-appropriate preventative care, such as reviewing immunization status, fall risk assessment, and chronic disease screening in the absence of new acute complaints.
Common Pitfalls
- Billing K132 alongside an acute care visit code (e.g., A007) is a common audit trigger; if an acute issue is addressed, the visit should be billed as an assessment rather than a periodic health visit.
- Submitting K132 more than once in a 12-month period by the same physician will result in an automatic rejection, as the Ministry strictly enforces the annual limit per provider.
Billing Tips
- Always append the E089 premium when billing K132 for eligible patients to capture the additional fee for gender-specific health screenings.
- Ensure the 15% age premium is applied to the K132 fee, as the code is specifically designated for patients 65 and older.
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