OHIP Virtual and Telephone Billing Codes: The Current Rules

Virtual care billing in Ontario is no longer a temporary arrangement bolted onto the Schedule of Benefits. It's a defined system with its own definitions, its own appendix of eligible codes, its own payment rates, and a set of conditions that will fail a claim if you don't meet them.

The structure most physicians never fully absorbed is the split between Comprehensive and Limited virtual care, and the requirement to attach a modality indicator to every comprehensive virtual claim. Get those two things right and most of the rest follows.

Everything below is from the current Schedule of Benefits, effective April 1, 2026.

The core distinction: comprehensive vs limited

| | Comprehensive Virtual Care | Limited Virtual Care | |---|---|---| | When it applies | An existing or ongoing patient-physician relationship exists | No such relationship exists | | How you claim it | The normal fee code with an A suffix, from Appendix J Section 1 | A101 (video) or A102 (telephone) | | What it pays | The corresponding in-person fee (video), or 85% of it (telephone) | $20.00 (video) / $15.00 (telephone) |

That's the whole fork. If you know the patient, you bill your regular code virtually. If you don't, you bill a flat limited-care fee.

What counts as an existing or ongoing relationship

This is defined, not left to judgment. A relationship exists if any of the following is true:

1. You have rendered at least one insured service involving a direct physical encounter with that patient in the preceding 24 months.
2. The patient has signed the ministry's Patient Enrollment and Consent form and is enrolled to you, or to another physician in your group, where the group is a signatory or locum to a ministry alternate funding plan agreement.
3. You are a specialist or GP Focused Practice Physician providing — or having provided in the preceding 24 months — a video consultation listed in Appendix J Section 1.
4. You provide, or provided in the preceding 24 months, certain specified virtual services, including A920 (medical management of early pregnancy, initial service by video or telephone), A945/C945 (special palliative care consultation by video), A320/C320 (special medical assistance in dying consultation by video), A680/C680 (initial assessment for substance abuse by video), the midwife-requested assessments A814/A817/A818, A253 (optometrist-requested assessment by video), A957 (addiction medicine focused practice by video), or K680 (substance abuse extended assessment by video).

Follow-up virtual services in the 24 months after a service under (3) or (4) can be claimed as comprehensive virtual care.

There's also a commentary worth reading if you refer patients: where the visit that led to a referral was itself virtual, the Schedule states it would be expected that the referring physician has an established relationship with the patient and that the clinical issue leading to the referral was assessed in person within the previous 12 months.

Video and telephone are not interchangeable

Telephone means synchronous audio-only communication — no visualization of the patient.

Video means two-way synchronous video conferencing with both audio and video visualization, and it carries a hard technical requirement: video services are only payable when performed using a Verified Virtual Visit Solution. That means a platform on Ontario Health's published verified vendor list. A generic consumer video call does not qualify, and the requirement is stated as a payment condition, not a recommendation.

Ontario Health maintains the current list of verified solutions on its virtual visits verification standard page.

Appendix J splits eligible services into two lists on exactly this basis:

• Video or telephone — a long list of everyday assessments and management codes, including A001A, A007A, A008A, most specialist office assessments, and the K-prefix counselling and management codes (K002A, K005A, K007A, K013A, K030A, K040A, and many more).
• Video only — a much longer list, covering consultations broadly: all the C-prefix inpatient consultations, most A-prefix specialist consultations, W-prefix codes, and services like A945A (special palliative care consultation).

The practical rule of thumb: assessments and follow-ups can generally be done by phone; consultations generally cannot. But check the appendix rather than trusting the heuristic — the split isn't perfectly clean.

The A suffix, and the modality indicator people forget

Comprehensive virtual care services are claimed using the A-suffix version of the normal fee code. An intermediate assessment rendered virtually is A007 claimed as A007A.

Then the part that gets missed: every comprehensive virtual claim must also carry a modality indicator.

| Code | Meaning | |------|---------| | K300A | Video technology was used during the service | | K301A | Telephone (audio only) was used during the service |

These identify how the service was delivered. They aren't optional descriptors — the Schedule's claims submission instructions require them.

Here's the counterintuitive part about the fee: submit the claim using the in-person fee value regardless of whether the service was rendered by video or telephone. You don't discount the claim yourself. The ministry applies the reduction automatically based on the modality indicator you submitted.

What virtual care actually pays

Video: 100% of the corresponding in-person fee.

Telephone: 85% of the corresponding in-person fee — except K005, K007, K197 and K198, which are payable at 95%.

So a virtual A007A by video pays the full $44.55. By telephone, it pays 85% of that. The gap is not enormous on a single visit, but across a practice that does a lot of phone follow-up it's the difference between a video platform paying for itself several times over and not.

Limited virtual care: A101 and A102

When there's no existing relationship, you're in Appendix J Section 2, and there are exactly two codes:

| Code | Service | Fee | |------|---------|-----| | A101 | Limited virtual care service by video | $20.00 | | A102 | Limited virtual care service by telephone | $15.00 |

The Schedule defines a limited virtual care service as an assessment that includes, at minimum, history-taking and a medically appropriate exam sufficient to arrive at a diagnosis and provide an appropriate management plan and/or management, plus the other specific elements of assessments where provided.

These are the codes that apply to walk-in-style virtual encounters with patients you've never met. They pay considerably less than the in-person equivalent, and that's deliberate.

GP focused practice virtual consultations

If you're a GP Focused Practice Physician — designated by the bilateral Ministry–OMA GP Focused Practice Review Committee, or eligible for the focused practice psychotherapy premium — there's a dedicated set of video consultation codes:

| Code | Service | Fee | |------|---------|-----| | A010 | GP focused practice consultation by video | $95.60 | | A011 | Repeat consultation by video | $47.10 | | A906 | Limited consultation by video | $80.15 | | A913 | Special consultation by video | $164.95 | | A914 | Comprehensive consultation by video | $247.40 |

A913 requires a minimum of 50 minutes of direct contact; A914 requires a minimum of 75 minutes. Video only.

Premiums that still apply virtually

Virtual care doesn't disqualify you from premiums. The Schedule sets out a specific list of what remains payable on a virtual service:

| Premium | Value on a virtual service | |---------|---------------------------| | E078 — chronic disease assessment premium | 50% | | E088 — congestive heart failure premium | 50% | | E098 — gastroenterology chronic disease assessment premium | 28% | | E060 — post renal transplant assessment premium | 25% | | E080 — first visit by primary care physician after hospital discharge | $25.90 (video only) | | E079 — initial smoking cessation discussion | $15.95 by video; 85% of that by telephone | | K187 — acute post-discharge community psychiatric care | 15% | | K188 — high-risk community psychiatric care | 15% | | K189 — urgent community psychiatric follow-up (video only) | $216.30 | | Age-based fee premiums | 10–30% | | Focused practice psychotherapy premium | 17% | | Internal medicine office assessment premium | 12% | | FHG in-basket premium | 10% |

Note E080 and K189 are video only. A post-discharge follow-up done by phone does not attract the premium.

Virtual care and management fees

Comprehensive virtual care services count as a consultation or assessment for the purpose of meeting the requirements of the management fees K045, K046, Q040, K119, K481, K682, K683, K684 and K030.

K030 has a condition attached. A virtual K030 — diabetic management assessment — is only eligible for payment if a K030 involving a direct physical encounter has been performed in the preceding 12 months. You cannot run a diabetic management program entirely virtually and expect it to pay.

The conditions that fail claims

Eleven terms and conditions govern virtual care. These are the ones that actually cost people money:

The service must be patient-initiated. Not payable unless initiated by the patient or the patient's representative, or unless it's a medically necessary follow-up to a preceding patient-initiated visit. Administrative staff can coordinate appointments and organize medically necessary follow-ups — but a physician-initiated "check-in" call is not payable, and neither are telephone or video encounters for administrative purposes.

Communicating normal results is not billable unless it's medically necessary because clinical management is being altered. And physician-initiated communication giving advice about a service you already rendered — calling to say a test was positive so fill the prescription — is a specific element of the original service, not a new one. The Schedule's own test: would this remote encounter have occurred in your in-person practice?

The modality must be documented on the medical record. Not payable otherwise. This is the easiest condition in the whole section and the easiest to fail on audit.

Both patient and physician must be physically located in Ontario. Under section 37.1 of Regulation 552 of the Health Insurance Act, services aren't insured otherwise. A patient calling from Florida is not a billable virtual visit.

Not payable when it isn't medically appropriate to deliver the service without a physical encounter. Two sub-rules matter here. If partway through you realize the service can't be completed appropriately without seeing the patient, the virtual service is not payable — only the in-person service is. Conversely, if the patient requests a virtual visit and isn't willing to attend in person despite your advice and availability, you may bill the service you rendered virtually.

Hospital inpatients and long-term care patients are largely excluded. Virtual care is not payable for these patients unless all three of the following hold: you are not the patient's most responsible physician; the hospital or LTC facility has no physician on staff present in the community with the expertise to render the service, documented by the referring physician in the record; and, for a virtual inpatient specialist consultation, an assessment with a direct physical encounter was completed by the referring physician within the 30 days preceding it, to confirm the need.

If the modality changes mid-service, only the service performed by the modality representing more than 50% of the time is payable. For time-based services, the combined time of both modalities counts toward the time units.

For time-based services, only time in direct communication with the patient or their representative counts.

In-person services must remain available — from you or your group — within a clinically appropriate timeframe if a physical encounter turns out to be necessary, or if the patient expressed a preference for in-person care at scheduling.

eConsult: K738 and K739

eConsult is a different mechanism from a virtual visit — no patient present, both request and opinion transmitted electronically through a secure server.

| Code | Role | Fee | |------|------|-----| | K738 | Referring physician | $16.45 | | K739 | Consultant physician | $20.50 |

The rules are tight:

• Only payable if the consultant provides an opinion and/or recommendations within 30 days of the request.
• Maximum 1 service per patient per day for each code.
• Maximum 6 services per patient, by any physician, per 12-month period.
• Maximum 400 services per physician per 12-month period.
• Not payable when the purpose is to arrange transfer of the patient's care; when rendered wholly or partly to arrange a consultation, assessment, visit, K-prefix time-based service, procedure or diagnostic investigation; when rendered primarily to discuss diagnostic results; or when the consultant renders a consultation, assessment, visit or K-prefix time-based service for the same patient on the same day or the next day.
• K739 is not payable to specialists in Dermatology (02) or Ophthalmology (23).
• K739 is only payable if the consultant includes the referring physician's or nurse practitioner's provider number on the claim.

One useful allowance: the referring service is payable in addition to visits or other services you provide to the same patient on the same day. Answering an eConsult question doesn't cancel the visit.

Records must include the patient's name and health number, the names of the referring physician or nurse practitioner and the consultant, the reason for the consultation, and the consultant's opinion and recommendations. Note that the General Preamble's definition and required elements for consultations do not apply to eConsults — they're their own thing.

Telephone consultations between physicians

Separate again from both virtual visits and eConsult: physician-to-physician and nurse-practitioner-to-physician telephone consultation.

| Code | Role | Fee | |------|------|-----| | K730 | Referring physician / NP | $37.05 | | K731 | Consultant physician | $47.75 | | K734 | Referring, on duty in ED or hospital urgent care clinic | $37.05 | | K735 | Consultant, on duty in ED or hospital urgent care clinic | $47.75 |

Key conditions: maximum one K730 or K734 per patient per day; maximum one K731 or K735 per patient per day; the service must include a minimum of 10 minutes of patient-related discussion; and both the referring physician or NP and the consultant must be physically present in Ontario at the time of service.

The medical record must include the patient's name and health number, the start and stop times of the discussion, the names of both physicians, the reason, and the opinion and recommendations. The time doesn't need to be continuous — cumulative same-day discussion between the same physicians about the same patient counts toward the ten minutes.

CritiCall

Consultations arranged through CritiCall Ontario have their own set:

| Code | Role | Fee | |------|------|-----| | K732 | Referring physician / NP | $37.05 | | K733 | Consultant physician | $47.75 | | K736 | Referring, on duty in ED or urgent care | $37.05 | | K737 | Consultant, on duty in ED or urgent care | $47.75 | | E150 | CritiCall review of complex neuroimaging, added to K733 | $44.00 |

Maximums: 2 of K732 or K736 (any combination) per patient per day; 1 of K733 or K737 per physician per patient per day; 3 of K733 or K737 (any combination) per patient per day; 1 E150 per physician per patient per day.

E150 is payable only to specialists in Neurosurgery (04) or Neurology (18), only for review of all complex neuroimaging (at least one brain and/or spinal CT, MRI or angiography), and only when the analysis is documented in the permanent medical record. It is not payable if the consultant renders a consultation, assessment, visit or K-prefix time-based service for the same patient on the same or next day.

A short checklist before you submit a virtual claim

1. Does an existing or ongoing relationship exist? → comprehensive (A-suffix) if yes, A101/A102 if no.
2. Is this code on the video-or-telephone list, or the video-only list?
3. If video: was a Verified Virtual Visit Solution used?
4. Did you attach K300A or K301A?
5. Did you claim the in-person fee value and let the ministry apply the telephone reduction?
6. Is the modality documented in the chart?
7. Were both you and the patient in Ontario?
8. Was the encounter patient-initiated, or a medically necessary follow-up to one?
9. Are there premiums that still apply — and are any of them video-only?

Where SnapBill fits

SnapBill has the full Schedule of Benefits built in, including Appendix J, so when you bill a service virtually the eligible codes, the required modality indicator, and the video-versus-telephone restriction are checked before the claim is submitted. A missing K300A/K301A, a video-only code claimed by phone, or a virtual K030 without a qualifying in-person K030 in the preceding twelve months gets flagged while you're still in the claim — with a plain-language note on which rule applies.

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Fees and rules verified against the OHIP Schedule of Benefits, effective April 1, 2026. Ontario Health's verified virtual visit solution list changes over time — check the current vendor list before assuming a platform qualifies. Browse individual codes on our billing code pages, or sign up free.