Q042A – Smoking cessation counselling fee
OHIP Critical Care Code — APPENDIX Q · Schedule of Benefits
Provides payment for smoking cessation counselling. This fee is available to physicians participating in eligible primary care models, including CCM, FHG, FHN, FHO, RNPGA, BSM, GHC, SJHC, SEAMO, WHA, and GP Focused HIV. The service is limited to a maximum of two per patient per year and can be provided as a comprehensive virtual care service.
When to Use
- Use Q042A as an add-on to a primary visit code (e.g., A007) when you provide dedicated, structured smoking cessation advice during a scheduled appointment.
- Apply this code during a virtual care visit for smoking cessation, as it is specifically listed as an eligible premium for comprehensive virtual care services.
Common Pitfalls
- Billing Q042A more than twice per patient per 12-month period will result in automatic rejection by the Ministry.
- Attempting to bill Q042A as a standalone service without an associated visit code (like A007 or K030) will lead to claim rejection, as it is a premium/add-on fee.
Billing Tips
- Ensure your primary care model is listed in the Appendix Q eligibility list before submitting, as this code is restricted to specific physician groups like FHO, FHN, and FHG.
Effective: April 1, 2026
AQ. Appendix Q
APPENDIX Q
Consultation
Other Premiums (including After Hours Procedure Premiums)
This fee is listed under 'Chronic Disease Management' for certain primary care models and also under 'Premiums Payable to Physicians When Providing Eligible Comprehensive Virtual Care Services'.
Eligible Models on page : CCM, FHG, FHN, FHO, RNPGA, BSM, GHC, SJHC, SEAMO, WHA
Eligible Models on page : BSM, CCM, FHG, FHN, FHO, GHC, GP Focused HIV, RNGPA, SJHC, WAHA
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