K200 – Group psychotherapy, in-patients - 4 people - per unit
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Group psychotherapy for in-patients where the group consists of 4 people. The service is billed per member, per unit of time. This service is for the first 12 units per patient per day; subsequent units are claimed using K207. A unit is defined as a half-hour or major part thereof, requiring a minimum of 20 minutes of direct physician contact as per . For full conditions and definitions, see the General Preamble ( to ).
When to Use
- Use K200 when facilitating a structured psychotherapy session for exactly 4 in-patients simultaneously, ensuring each patient's chart reflects the specific start and end times.
- Use K200 for the first 12 units (6 hours) of group therapy provided to an in-patient; once this threshold is exceeded, switch to K207 for subsequent units.
Common Pitfalls
- Billing K200 without explicitly documenting the exact start and end times in the patient's chart, which is a mandatory requirement under GP7 for all unit-based services.
- Attempting to bill K200 alongside a consultation or assessment code on the same day for the same diagnosis, which triggers automatic payment adjustments or rejections.
- Claiming K200 for sessions lasting less than 20 minutes, as these do not meet the 'major part' definition of a 30-minute unit and are considered non-billable as psychotherapy.
Billing Tips
- Ensure the group size remains strictly at 4 participants; if the group size fluctuates, you must use the appropriate code for that specific group size (e.g., K201 for 5 patients) to avoid audit discrepancies.
- Always verify that no other psychiatric care or individual psychotherapy (e.g., K007) has been billed by you for the same patient on the same day, as these are mutually exclusive.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Psychotherapy, Psychiatric and Counselling Services, Hospital and Institutional Consultations and Assessments
For any service where the amount is based upon the number of 'units' of service rendered, 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.
1. For conditions and definitions - see General Preamble to .
2. For electroconvulsive therapy fees, see Diagnostic and Therapeutic Procedures.
3. When claiming group therapy only services rendered to one group are payable at the same time.
4. Unit means ½ hour or major part thereof - see General Preamble , for definitions and time-keeping requirements.
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