K269 – Periodic health visit - 12 - 17 years of age
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic health visit (including a primary or secondary school examination) is performed on a patient, after their second birthday, who presents and reveals no apparent acute physical or mental illness. The service must include an intermediate assessment, a level 2 paediatric assessment or a partial assessment focusing on age and gender appropriate history, physical examination, health screening and relevant counselling. As per page , this code applies specifically when rendered by a paediatrician to a patient 12 to 17 years of age. See for general rules on Periodic Health Visits.
When to Use
- Use K269 for a routine annual physical for a 12-17 year old patient when no acute illness is present, distinguishing it from K267 which is restricted to patients under 12.
- Use this code for school-mandated physical examinations for adolescents in the 12-17 age bracket.
- Use K269 when performing age-appropriate health screening and counseling for an adolescent who is otherwise healthy.
Common Pitfalls
- Billing K269 for a patient who presents with an acute issue, such as an ear infection or injury, which requires an A007 or K013 instead.
- Attempting to bill K269 alongside a minor assessment or counseling code for the same date, which will trigger a rejection as the periodic visit is intended to be comprehensive.
- Exceeding the annual frequency limit for periodic health visits, which will result in automatic rejection by the Ministry.
Billing Tips
- Ensure the patient's age is strictly between 12 and 17 inclusive at the time of service, as claims for patients turning 18 will be rejected.
- If an acute issue is addressed during the same visit, you must bill the appropriate assessment code (e.g., A007) instead of K269, as K269 requires the absence of acute illness.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
12 - 17 years of age
For definitions and payment rules - see General Preamble .
Diagnostic interview and/or counselling with child and/or parent - see listings in Family Practice & Practice in General.
No diagnostic code is required unless otherwise specifically listed. ()
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.