K201 – Group psychotherapy, in-patients - 5 people - per member - first 12 units per day
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
`K201` is for in-patient group psychotherapy rendered to a group of 5 people, billed per member, per unit. This fee is applicable to the first 12 units per day for the group session. A psychotherapy unit is defined as a half-hour or major part thereof, with a minimum of 20 minutes of direct contact with the patient(s). Psychotherapy is defined as 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 the patient(s) with the purpose of removing, modifying or retarding existing symptoms, attenuating or reversing disturbed patterns of behaviour, and promoting positive personality growth and development.
When to Use
- Use K201 when conducting a structured psychotherapy session for exactly 5 in-patients simultaneously, ensuring each patient receives at least 20 minutes of direct interaction per unit.
- Select K201 over K190 when the therapeutic modality specifically requires a group dynamic to address emotional or behavioural maladaptations in an institutional setting.
Common Pitfalls
- Billing K201 for groups smaller than 5 patients will result in a rejection or audit recovery; use K200 for groups of 2-4 or K202 for groups of 6-8.
- Failing to document the exact start and end times for the session is a common audit failure, as the Ministry requires proof that the 'major part' of the 30-minute unit was met.
- Attempting to bill K201 alongside individual psychotherapy (K190) for the same patient on the same day is prohibited and will cause a claim rejection.
Billing Tips
- Since K201 is billed per member, ensure you submit a separate claim for each of the 5 patients, referencing the same group session time in your records to maintain consistency during an audit.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Procedure
Psychotherapy, Psychiatric and Counselling Services, Hospital and Institutional Consultations and Assessments
The time when the insured service started and ended must be recorded in the patient's permanent medical record or chart.
For conditions and definitions - see to .
For electroconvulsive therapy fees, see Diagnostic and Therapeutic Procedures.
When claiming group therapy only services rendered to one group are payable at the same time.
Unit means ½ hour or major part thereof - see , for definitions and time-keeping requirements.
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