K205 – Group psychotherapy, out-patients - 6 to 12 people
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Group psychotherapy for out-patients, applicable when the group size is between 6 and 12 people. The service is billed per member per time unit. A time unit is defined as half an hour or a major part thereof, with specific minimum time requirements detailed in the General Preamble (e.g., 20 minutes for the first unit). This fee code applies to the first 12 units claimed per patient, per day. For additional units, see K206. Refer to General Preamble pages through for comprehensive definitions, conditions, and time-keeping requirements for psychotherapy services.
When to Use
- Use K205 when facilitating a structured psychotherapy session for a group of 6 to 12 patients where the focus is on therapeutic intervention rather than simple support or education.
- Apply K205 for the first 12 units (6 hours) of group therapy per patient per day, transitioning to K206 only after the 12th unit is exceeded.
Common Pitfalls
- Billing K205 on the same day as a consultation or assessment (e.g., A007) for the same patient will trigger an automatic rejection unless distinct, unrelated diagnoses are documented for each service.
- Failing to record exact start and end times in the patient chart is the most common cause of audit recovery, as the Ministry strictly enforces the 'major part thereof' rule for each 30-minute unit.
Billing Tips
- Ensure the group size remains within the 6-12 member range; if attendance drops below 6, the service must be billed as individual psychotherapy (e.g., K007) rather than K205.
- Maintain a separate log of all participants present for the session to justify the group size requirement in the event of an audit.
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. If this information is not included, the service is not eligible for payment.
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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