K198 – Out-patient psychiatric care
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Psychiatric care encompasses any combination or form of assessment and treatment by a physician for mental illness, behavioural maladaptations, and/or other problems that are assumed to be of an emotional nature, where there is consideration of the patient's biological and psychosocial functioning. This service is for an out-patient and is billed per unit. Per the note on , one unit is defined as ½ hour or a major part thereof. In addition to the , common elements, this service includes the following specific elements: - Performing the appropriate therapy or interaction with the patient, which may include inquiries (such as history taking and a brief physical examination) to arrive at an opinion as to the nature of the patient's condition. - Performing any procedures during the same encounter unless the procedure is separately listed in the Schedule and payable in conjunction with the therapy. - Making arrangements for related assessments, procedures, or therapy. - Making arrangements for follow-up care. - Discussing 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 specific elements.
When to Use
- Use K198 for ongoing psychotherapy or psychiatric management sessions lasting at least 20 minutes where the primary focus is mental health treatment.
- Use K198 when providing follow-up care that involves active therapeutic intervention rather than a brief medication review or routine assessment.
Common Pitfalls
- Billing K198 for sessions under 20 minutes, which are ineligible for this code and should be billed as a standard office visit (e.g., A007).
- Submitting K198 on the same day as a consultation (A-prefix codes) without documenting a distinct, unrelated diagnosis for each service, leading to automatic rejection.
- Failing to document the exact start and end times in the chart, which is a mandatory requirement for all time-based psychiatric services.
Billing Tips
- Ensure the total duration is clearly recorded; since one unit is 30 minutes, a 45-minute session qualifies as two units (major part of the second half-hour).
- If the patient meets criteria for K187 or K188, apply the 15% premium to the K198 base fee to maximize reimbursement for high-risk or post-discharge patients.
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.
When rendered by a Medical Trainee under supervision, the medical record must identify: the Supervising Physician; the Medical Trainee and level of training; the description of the insured service; patient consent to supervision; and evidence that the Supervising Physician has reviewed the service with the trainee. The Supervising Physician must sign off on the service or the trainee must document the discussion.
Psychiatric care performed outside a hospital, psychiatric care, primary mental health care, or hypnotherapy rendered the same day as a consultation or other assessment by the same physician to the same patient is not eligible for payment unless there are clearly defined different diagnoses for the two services.
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.
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