K206 – Group psychotherapy, out-patients - additional units
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
K206 is for additional units of group psychotherapy for out-patients, payable per member, per unit. Definition of Psychotherapy Psychotherapy is 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 a patient with the purpose of removing, modifying or retarding existing symptoms, or attenuating or reversing disturbed patterns of behaviour, and of promoting positive personality growth and development. This service is for additional units of group psychotherapy for out-patients, after the first 12 units per day (billed under codes K208 to K205) have been rendered to the group. A maximum of 6 additional units using K206 may be claimed per patient per day. Unit and Time Requirements A unit is defined as ½ hour or a major part thereof. The time is calculated based on consecutive time spent with the patient(s). The minimum time requirements are: - 1 unit: 20 minutes - 2 units: 46 minutes - 3 units: 76 minutes - 4 units: 106 minutes - 5 units: 136 minutes - 6 units: 166 minutes - 7 units: 196 minutes - 8 units: 226 minutes Services less than 20 minutes in duration do not constitute psychotherapy and should be claimed as an assessment appropriate to the circumstances.
When to Use
- Use K206 only after the initial 12 units of group psychotherapy (billed under K208-K205) have been exhausted for the patient on the same day.
- Apply K206 for extended group sessions exceeding 6 hours of total duration, up to a maximum of 6 additional units per patient per day.
Common Pitfalls
- Billing K206 before the primary group psychotherapy codes (K208-K205) reach the 12-unit threshold, which will trigger an automatic rejection.
- Failing to document the exact start and end times for the additional units, which is a mandatory requirement for audit compliance under GP7 and GP55.
- Attempting to bill K206 for services totaling less than 20 minutes, which fails the definition of a psychotherapy unit and should be billed as a standard assessment.
Billing Tips
- Ensure the total time calculation for K206 units accounts for the cumulative duration of the group session, keeping in mind that each unit requires a 'major part' of 30 minutes.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Psychiatry
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 the patient's permanent medical record or chart does not include this required information, the service is not eligible for payment.
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.
When claiming group therapy only services rendered to one group are payable at the same time.
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