K195 – Family psychotherapy - out-patients (two or more members)
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Family psychotherapy is psychotherapy rendered to the patient in the presence of one or more members of the patient's household. Psychotherapy is a form of treatment for mental illness, behavioural maladaptations, and/or other problems that are assumed to be of an emotional nature, where a physician deliberately establishes a professional relationship with a patient for the purpose of removing, modifying or retarding existing symptoms, attenuating or reversing disturbed patterns of behaviour, and of promoting positive personality growth and development. In addition to the common elements, this service includes the following specific elements: - Performing the appropriate therapy or interaction with the patient(s) which may include appropriate inquiries (including history and brief physical examination) to arrive at an opinion as to the nature of the patient's condition. - Performing any procedure(s) during the same encounter, unless separately listed in the Schedule. - Making arrangements for any related assessments, procedures, or therapy. - Making arrangements for follow-up care. - Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative. - When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is rendered. - Providing premises, equipment, supplies, and personnel for the specific elements of the service.
When to Use
- Use K195 when conducting a therapy session involving the primary patient and at least one other household member to address family-based emotional or behavioural disturbances.
- Use K195 for joint sessions where the therapeutic focus is on the primary patient's condition, rather than a general family counseling session where no specific patient is identified as the primary focus.
Common Pitfalls
- Billing K195 for sessions under 20 minutes, which fails the minimum time requirement and should instead be billed as a standard office visit (e.g., A007).
- Failing to record the exact start and end times in the clinical note, which is a mandatory requirement for all psychotherapy codes and a common cause of audit recovery.
- Billing K195 on the same day as a consultation or assessment (e.g., A005) for the same patient without distinct, unrelated diagnoses, which will trigger an automatic rejection.
Billing Tips
- Ensure the claim is submitted under the primary patient's health number, even if multiple family members are present, as the service is defined as therapy rendered to the patient in the presence of others.
- Remember that K195 is calculated in 30-minute units (or major parts thereof); ensure your documented time clearly justifies the number of units claimed.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Psychotherapy, Psychiatric and Counselling Services
The physician must record on the patient's permanent medical record or chart the time when the insured service started and ended. If the patient's permanent medical record or chart does not include this required information, the service is not eligible for payment.
For conditions and definitions - see General Preamble to .
Unit means ½ hour or major part thereof - see General Preamble , for definitions and time-keeping requirements.
Family psychotherapy is claimed against the patient's health number and diagnosis.
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