Q040 – Diabetes management incentive
OHIP Critical Care Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Diabetes management incentive (DMI) is a service rendered by the General/Family Physician most responsible for providing ongoing management of a diabetic patient. The service consists of ongoing management using a planned care approach consistent with the required elements of the Canadian Diabetes Association (CDA) Clinical Practice Guidelines, documenting that all of the CDA required elements have been provided for the previous 12 month period and must include documentation that tracks, at a minimum, the following: - Lipids, cholesterol, HbA1C, blood pressure, weight and body mass index (BMI), and medication dosage; - Discussion and offer of preventive measures including vascular protection, influenza and pneumococcal vaccination; - Health promotion counselling and patient self-management support; - Albumin to creatinine ratio (ACR); - Discussion and offer of referral for dilated eye examination; and - Foot examination and neurologic examination.
When to Use
- Use Q040 once annually after you have completed at least three K030 diabetes management sessions for the patient within the same 12-month period.
- Submit this code only after verifying that all CDA-mandated clinical elements, including foot/neurologic exams and ACR testing, have been documented in the patient's chart within the last year.
Common Pitfalls
- Billing Q040 before the three required K030 sessions are fully rendered and submitted will result in an automatic rejection.
- Failing to document the specific offer of a dilated eye exam or pneumococcal vaccination will lead to a clawback during a Ministry audit, even if the clinical management was otherwise excellent.
- Submitting Q040 more than once in a 12-month rolling period will trigger a rejection as it is strictly limited to one payment per patient per year.
Billing Tips
- Use a standardized EMR diabetes flow sheet that auto-populates the required CDA elements to ensure you have a defensible audit trail for every mandatory metric.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
ManagementFee
Assessments
A flow sheet or other documentation that records all of the required elements of the most current CDA guidelines must be included in the patient's permanent medical record, or the service is not eligible for payment.
The flow sheet must track, at a minimum, the following: - Lipids, cholesterol, HbA1C, blood pressure, weight and body mass index (BMI), and medication dosage - Discussion and offer of preventive measures including vascular protection, influenza and pneumococcal vaccination - Health promotion counselling and patient self-management support - Albumin to creatinine ratio (ACR) - Discussion and offer of referral for dilated eye examination - Foot examination and neurologic examination
Claims for Q040 must be submitted only when the required elements of the service have been completed for the previous 12 month period.
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