K211 – Group psychotherapy, in-patients - 3 people - per unit
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is for group psychotherapy provided to an in-patient in a group setting with 3 people, billed per member, per unit. A unit is defined as a half-hour or major part thereof (see time-keeping requirements in the General Preamble on page ). 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 for 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 limited to the first 12 units per day per member; additional units (up to a maximum of 6 per patient per day) must be claimed using K207. For full conditions and definitions, see General Preamble pages to .
When to Use
- Use K211 when conducting a structured psychotherapy session for exactly three hospitalized patients simultaneously, where the focus is on modifying emotional symptoms or behavioral patterns.
- Use this code for the first 12 units (6 hours) of group therapy per patient per day, reserving K207 only for units exceeding this daily limit.
Common Pitfalls
- Failing to maintain a separate, non-chart log of all attendees' health numbers and names, which is a mandatory audit requirement distinct from the patient's individual medical record.
- Incorrectly billing K211 for a group of four or more patients, which requires using K212 or other appropriate group codes instead.
- Submitting claims under the wrong patient's health number; the claim must be billed to the patient who has the highest cumulative count of psychotherapy units for the year.
Billing Tips
- Ensure the start and end times are explicitly recorded in each patient's chart, as a 'unit' is strictly defined as 30 minutes or a major part thereof (at least 16 minutes).
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.
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 group psychotherapy session or 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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