K133 – Periodic health visit for adults with Intellectual and Developmental Disabilities (IDD)
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic health visit for adults with IDD is a service performed on an adult with IDD that consists of an intermediate assessment, appropriate history, physical examination, health screening and relevant counselling, and a coordinated care and management plan consistent with the current Canadian consensus guidelines on the primary care of adults with IDD.
When to Use
- Use K133 annually for patients with a confirmed diagnosis of an intellectual or developmental disability, replacing standard periodic health visits like K017.
- Select K133 when performing a comprehensive health review that includes specific sensory screening (hearing, vision, dentition) and a coordinated care plan tailored to IDD guidelines.
Common Pitfalls
- Billing K133 more than once per 12-month period per patient, which will trigger an automatic rejection as it is a periodic health service.
- Failing to document the mandatory written communication of the care plan to the caregiver or guardian, which is a specific requirement for this code unlike standard K017 visits.
- Billing K133 in conjunction with other visit codes on the same day without ensuring the services are distinct and medically necessary, as this often leads to audit scrutiny.
Billing Tips
- Ensure your EMR template includes a checklist for the mandatory physical exam components (hearing, vision, dentition, musculoskeletal, neurological) to satisfy the specific documentation requirements of the Schedule of Benefits.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
Evaluation for and identification of any need for special accommodations in clinical settings as well as other health care access issues,
Proactive review of the patient's genetic and psychosocial risks,
Review of any chronic diseases,
Review of systems,
An in-person physical examination that includes, at a minimum: i. Measurement of vital signs including weight or waist circumference, ii. Screening for abnormalities in hearing, vision, and dentition, iii. Screening examination of musculoskeletal and neurological systems, iv. Survey examination of skin, v. Detailed examination of any part(s), region(s) or system(s) needed to make a diagnosis, and/or rule out disease as a contributing factor
Documentation of a coordinated care and management plan,
Written communication of the care and management plan to the patient and their guardian, legal representative or other caregiver
Adult with Intellectual and Developmental Disability (IDD)
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