K197 – Individual out-patient psychotherapy
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
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 with the purpose of removing, modifying or retarding existing symptoms, or attenuating or reversing disturbed patterns of behaviour, and of promoting positive personality growth and development. This service is provided to an individual patient in an out-patient setting. In addition to the - common elements, this service includes the following specific elements as per : - Performing the appropriate therapy or interaction with the patient, which may include inquiries like history taking and a brief physical examination. - Performing any procedure(s) during the same encounter unless separately listed and payable. - Making arrangements for related assessments, procedures, or therapy. - Arranging follow-up care. - Discussion with, and providing advice and information to the patient or the patient's representative. - When medically indicated, monitoring the patient's condition and intervening until the next insured service is provided. - Providing premises, equipment, supplies, and personnel for the service.
When to Use
- Use K197 for dedicated, time-based psychotherapy sessions where the primary focus is therapeutic intervention for mental health conditions, rather than a standard office visit (A007).
- Use K197 when the encounter duration exceeds the time typically allocated for a standard assessment or follow-up, specifically to address emotional or behavioural maladaptations.
Common Pitfalls
- Billing K197 on the same day as a consultation or assessment (e.g., A007, A008) without documenting a distinct, unrelated diagnosis for each service will trigger an automatic rejection.
- Failing to document the exact start and end times in the medical record is the most frequent cause of audit recovery, as K197 is strictly a time-based code.
- Attempting to bill K197 for routine medication management or brief supportive counseling that does not meet the definition of psychotherapy as outlined in the General Preamble.
Billing Tips
- Ensure the total time documented reflects the 'major part' of the 30-minute unit; for example, a 16-minute session qualifies for one unit, while 46 minutes qualifies for two units.
- If you are a psychiatrist or eligible specialist, remember to append the K187 or K188 premium to the K197 claim if the patient meets the specific post-discharge or post-suicide attempt criteria.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Service
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.
For conditions and definitions - see General Preamble to .
For electroconvulsive therapy fees, see Diagnostic and Therapeutic Procedures.
Unit means ½ hour or major part thereof - see General Preamble , for definitions and time-keeping requirements.
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