K204 – Group psychotherapy, out-patients - 5 people - per unit
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Group psychotherapy for 5 out-patients, billed per member, per unit. Per the General Preamble, psychotherapy is a form of treatment for mental illness, behavioural maladaptations, and/or other problems of an emotional nature, where a physician establishes a professional relationship with a patient for therapeutic purposes. A unit is defined as a half-hour or major part thereof, with a minimum of 20 minutes required for the first unit, as outlined on . This fee code is used for the first 12 units per patient per day; subsequent units are claimed under K206. Claims are submitted under the health number of one group member.
When to Use
- Use K204 when conducting a structured group psychotherapy session for exactly 5 patients where the session duration is at least 20 minutes.
- Use this code for the first 12 units (6 hours) of group therapy per patient per day, transitioning to K206 for any units beyond this threshold.
Common Pitfalls
- Submitting claims under the wrong patient's health number; you must prioritize the patient who has already accumulated the highest number of counselling units for the year.
- Failing to maintain a separate, session-specific log of all attendees' health numbers, which is a mandatory audit requirement distinct from individual patient charts.
- Billing K204 on the same day as a consultation or assessment (e.g., A007) for the same patient without documenting a distinct, unrelated diagnosis for each service.
Billing Tips
- Ensure the session duration is clearly documented with start and end times in the clinical record to justify the number of 30-minute units claimed.
- Verify that the group size remains at 5; if the group size fluctuates, you must switch to the appropriate code (e.g., K203 for 3 patients or K205 for 6 patients) to avoid rejection.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Psychotherapy
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 group sessions, the physician must maintain a separate record (independent of the patient's medical record) of the names and health numbers of all persons in attendance at each session.
For conditions and definitions - see General Preamble 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 General Preamble , for definitions and time-keeping requirements.
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