K480 – Physician to allied professional telephone consultation
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This is the service where the rheumatologist participates in a telephone consultation with one or more of the following allied professionals who is funded by and affiliated with the Arthritis Society, Ontario Division: - a physiotherapist who is a member of the College of Physiotherapists of Ontario; - an occupational therapist who is a member of the College of Occupational Therapists of Ontario; or - a social worker who is a member of the Ontario College of Social Workers and Social Service Workers.
When to Use
- Use K480 when discussing a complex treatment plan or functional goal adjustment for a patient with an Arthritis Society-affiliated physiotherapist or occupational therapist.
- Use K480 when coordinating psychosocial support or complex care transitions with an Arthritis Society-affiliated social worker for a patient with an established rheumatological diagnosis.
Common Pitfalls
- Billing K480 more than twice in a rolling 12-month period will result in automatic rejection by the Ministry.
- Failing to document the exact start and stop times totaling at least 10 minutes is a frequent cause of audit recovery, as the Ministry strictly enforces the duration requirement.
- Attempting to bill K480 when the discussion is merely to schedule an appointment or arrange an evaluation, which is explicitly excluded by the Schedule.
Billing Tips
- Ensure the allied professional is specifically affiliated with the Arthritis Society, as K480 cannot be used for consultations with independent allied health providers not under that specific organizational umbrella.
- Since K480 is eligible for payment in addition to other services on the same day, always bill it alongside your office visit (A007) or consultation (A005) if the discussion occurs on the same date.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Assessments
Patient's name and health number
Start and stop times of the discussion
Name(s) of the allied professional participating in the telephone consultation
Reason for the consultation
The opinion and recommendations of the physician
A maximum of one K480 service is eligible for payment per patient per day.
A maximum of two K480 services are eligible for payment per patient per 12 month period.
K480 is only eligible for payment for a physician to allied professional telephone consultation that includes a minimum of 10 minutes of patient-related discussion and where there is an established physician-patient relationship.
K480 is not eligible for payment to the physician in the following circumstances: - when the purpose of the telephone discussion is to arrange for an evaluation of the patient by the physician; or - in circumstances where a physician receives compensation, other than by fee-for-service under this Schedule, for participation in the telephone consultation.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.