K207 – Group psychotherapy, in-patients - additional units - per member (maximum 6 per patient per day)
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This fee code is for additional units of group psychotherapy for in-patients, per member, after the first 12 units per day have been claimed.
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 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 (see ).
This service is time-based, calculated in units of ½ hour or major part thereof. See unitBasedInfo for specific time requirements per unit. As per , the start and end times of the service must be recorded in the patient's medical record.
When to Use
- Use K207 only after the initial 12 units (6 hours) of group psychotherapy have been claimed for the same patient on the same day.
- Use this code for inpatient group sessions exceeding the 6-hour threshold when the physician is actively facilitating the psychotherapy session.
Common Pitfalls
- Claiming K207 before exhausting the primary group therapy codes (K200-K202) will result in automatic rejection.
- Failing to document exact start and end times in the chart is a common audit failure, as K207 is strictly time-based per 30-minute unit.
- Billing K207 for multiple groups occurring simultaneously is prohibited; only one group session can be claimed at any given time.
Billing Tips
- Ensure the total units claimed across all group therapy codes for the day do not exceed the clinical reality of the patient's inpatient stay to avoid scrutiny.
- Always verify that the session duration meets the 'major part thereof' rule (at least 16 minutes) for each unit claimed beyond the 12th unit.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Procedure
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 supervised by a Supervising Physician, the medical record must identify the Supervising Physician, the Medical Trainee, the service performed, patient consent, and that the Supervising Physician reviewed the service with the trainee. The record must be signed off by the Supervising Physician or include a note of discussion.
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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