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Family Practice — office OHIP billing codes
Office visits, periodic health visits, counselling, common procedures, forms, and the special-visit and after-hours premiums that ride along with them.
51 codes in 12 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 00 is in the full Family Practice listing.
Office visits
Periodic health visits
- K017Periodic health visit - childA periodic health visit for a child (age 2 to 15 inclusive), performed on a patient who presents without any apparent acute physical or mental illness. The service focuses on age-appropriate history, physical examination, health screening, and relevant counselling.$49.55
- K130Adolescent periodic health visitA periodic health visit for an adolescent patient aged 16 or 17. This service is a preventive health check for a patient with no apparent acute physical or mental illness and is limited to one per patient per physician per 12-month period.$87.10
- K131Periodic health visit - adult age 18 to 64 inclusiveA periodic health visit for an adult patient aged 18 to 64 inclusive who presents with no apparent acute physical or mental illness. The service includes an assessment focused on age and gender-appropriate history, physical examination, health screening, and relevant counselling.$64.25
- K132Periodic health visit - adult 65 years of age and olderA periodic health visit for an adult 65 years of age or older, performed on a patient who presents with no apparent acute physical or mental illness. The service includes an age and gender-appropriate history, physical examination, health screening, and relevant counselling.$91.35
Counselling & mental health
- K005Individual careTime-based service for individual primary mental health care, calculated in units of ½ hour or major part thereof. This service cannot be billed on the same day as other consultations or assessments by the same physician for the same patient, unless for a clearly different diagnosis.$80.00
- K007Individual careIndividual psychotherapy for mental illness, behavioural maladaptations, or emotional problems. This is a time-based service billed in units of 30 minutes, with the first unit requiring a minimum of 20 minutes of direct patient contact.$80.00
- K013Individual careTime-based individual counselling for a patient, limited to the first three units per 12-month period, combined with group counselling (<billingCode>K040</billingCode>). It is a visit dedicated solely to an educational dialogue with a physician.$80.00
- K033Individual care - additional unitsPayable for additional units of individual counselling after the first three units of combined counselling (<billingCode>K013</billingCode> and <billingCode>K040</billingCode>) have been claimed per patient, per provider, per 12-month period. Each unit represents a half-hour or major part thereof.$56.30
- K004Family psychotherapyFamily psychotherapy for two or more family members in attendance at the same time. This is a time-based service billed in units of ½ hour (or major part thereof).$86.85
- K002Interviews with relatives or authorized decision makerA time-based interview with a patient's relatives or authorized decision-maker when medically necessary information cannot be obtained from the patient. Requires a separate, booked appointment of at least 20 minutes.$80.00
- K015Counselling of relatives - on behalf of catastrophically or terminally ill patientA time-based counselling service for one or more relatives of a catastrophically or terminally ill patient. This service is billed in half-hour units and must be claimed under the patient's health number.$80.00
Chronic disease & focused assessments
- K030Diabetic Management AssessmentAn all-inclusive service for the most responsible physician providing continuing management of a diabetic patient, which includes a specific type of assessment, counselling, and maintenance of a diabetic flow sheet. This service is limited to four times per patient per 12-month period.$45.75
- K032Specific Neurocognitive AssessmentA specific neurocognitive assessment of neurocognitive function, rendered personally by the physician, that requires a minimum of 20 minutes for testing and scoring, with start and stop times documented.$80.00
Virtual care
Injections, immunizations & procedures
- G372Intramuscular, subcutaneous or intradermal injection with visitA single intramuscular, subcutaneous, or intradermal injection given during a visit with another service, or as an additional injection when multiple injections are given. This service can be delegated to a physician's employee under specific conditions.$4.55
- G538Other immunizing agents not listed aboveFee for administering an immunizing agent not otherwise specified in the Schedule. This service is an add-on to a visit, but if it is the sole reason for the visit, <billingCode>G700</billingCode> should also be claimed.$8.80
- G590Influenza agentAdministering the influenza vaccine. This service, often added to a visit, can be billed with <billingCode>G700</billingCode> if it's the sole purpose of the encounter and can be performed by a delegate under specific conditions.$8.80
- G365Collection of cervical cancer screening specimen(s)Payable for the collection of a specimen for cervical cancer screening. An additional amount (<billingCode>E430</billingCode>) is payable when performed outside of a hospital or ICHSC, and this service is included in the monthly management fee for nursing home patients (W010).$12.00
- G313Electrocardiogram - professional componentProvides payment for the professional component of a twelve-lead electrocardiogram (ECG), which requires a written interpretation. Payment is restricted for routine pre-operative screening and asymptomatic patients.$4.55
- G310Electrocardiogram - twelve lead - technical componentRepresents the technical component of a twelve-lead electrocardiogram (ECG). This service is not payable for routine pre-operative screening or for asymptomatic patients unless specific clinical indications or risk factors are present.$7.70
- G700Basic fee-per-visit premium for procedures marked (+)A premium added to specific (+) marked procedures when it is the sole reason for a visit. Not payable with an assessment or in a hospital setting.$8.80
Forms & certificates
- K070Home care applicationCompletion of home care referral form$34.75
- K035Mandatory Reporting of Medical Condition to the Ontario Ministry of TransportationService for a physician's mandatory reporting of a patient's medical condition to the Ontario Ministry of Transportation (MTO), as required by the *Highway Traffic Act*.$36.25
- K031Mandatory Blood Testing Act - Physician ReportA service for the completion of Form 1, the physician report required under the Mandatory Blood Testing Act.$105.20
- K623Application for psychiatric assessmentA psychiatric assessment for the purpose of completing a Form 1 application under the *Mental Health Act*. This service includes the necessary history, examination, and required notifications.$133.60
- A771Certification of death$24.20
- A777Intermediate assessment - Pronouncement of death$44.55
House calls & home special visits
- A902House call assessment - Pronouncement of death in the home$64.80
- B990First person seen - Patient's Home - Weekdays Daytime (07:00-17:00) or Elective home visitA premium for the first person seen during a non-elective special visit to a patient's home (other than a long-term care institution), for visits that commence on a weekday between 07:00 and 17:00; or for an elective home visit at any time.$28.25
- B993First person seen - Patient's Home - Sat., Sun. and Holidays (07:00-24:00)A premium for the first person seen during a non-elective special visit to a patient's home (other than a long-term care institution), for visits that commence on a Saturday, Sunday or holiday between 07:00 and 24:00.$84.80
- B992First person seen - Patient's Home - Weekdays Daytime (07:00-17:00) with Sacrifice of Office HoursA premium for the first person seen during a non-elective special visit to a patient's home (other than a long-term care institution), for visits that commence on a weekday between 07:00 and 17:00 with sacrifice of office hours.$45.25
- B994First person seen - Patient's Home - Evenings (17:00-24:00) Monday through FridayA premium for the first person seen during a non-elective special visit to a patient's home (other than a long-term care institution), for visits that commence Monday to Friday between 17:00 and 24:00.$67.85
- B996First person seen - Patient's Home - Nights (00:00-07:00)A premium for the first person seen during a non-elective special visit to a patient's home (other than a long-term care institution), for visits that commence between 00:00 and 07:00 on any day.$113.10
Palliative home visits
- B997First person seen - Palliative Care Home Visit - Nights (00:00-07:00)A premium for the first person seen during a non-elective special visit to a patient's home for palliative care, for visits that commence between 00:00 and 07:00 on any day.$113.10
- B998First person seen - Palliative Care Home Visit - Any day 07:00-24:00 (weekdays, evenings, Sat., Sun. and Holidays)A premium for the first person seen during a non-elective special visit to a patient's home for palliative care, for visits that commence on any day between 07:00 and 24:00 (nights have their own code).$91.80
Post-discharge & ED-equivalent
- E080First visit after hospital discharge premiumA premium payable to a patient's primary care physician for the first visit in their office or the patient's home that occurs within two weeks of discharge from an acute care hospital in-patient admission.$25.90
- A888Emergency department equivalent - partial assessment$44.55
How to use this family practice code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to family practice and practice in general (specialty 00) — its own consultation and assessment codes, in-patient visits, premiums and the diagnostics or procedures that make up most of a day — sectioned the way a shift sheet reads. Codes open to every specialty that a family practice physician also bills (general assessments, forms, special visit premiums) live in the Family Practice and Special visit premiums sets.
Each code links to its full Schedule entry: fee history, restrictions, required diagnoses and the codes it can or cannot be billed with. Fees shown are the current provider or specialist fee; percentage premiums show the percentage they add to the base service.
Common questions
Which consultation or assessment code does family practice — office bill?
The office visits section of this set starts with A007 (Intermediate assessment or well baby care), which pays $44.55 under the current Ontario Schedule of Benefits. 7 codes are listed in that section.
What is in the Family Practice — office code set?
51 OHIP billing codes across 12 sections: Office visits; Periodic health visits; Counselling & mental health; Chronic disease & focused assessments; Virtual care; Injections, immunizations & procedures; Forms & certificates; Special visit premiums — office (first person seen); House calls & home special visits; Palliative home visits; After-hours premiums (FHO / FHG / FHN / CCM); Post-discharge & ED-equivalent. Office visits, periodic health visits, counselling, common procedures, forms, and the special-visit and after-hours premiums that ride along with them.
Are these the current OHIP fees?
Fees are read from the current Ontario Schedule of Benefits for Physician Services and refreshed hourly. Claims are paid at the fee in force on the service date, so always confirm the effective date on the code page.
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