Family Medicine OHIP Billing Guide: Every Code and Current Fee (2026)

Family medicine covers more of the Schedule of Benefits than any other specialty. A family physician can see a well baby, a diabetic review, a counselling session, a joint injection and a nursing home round in one day, and each of those has its own code, fee and set of payment rules. This guide covers every part of family medicine billing in Ontario, with the current fee for each code and the rule that most often decides whether the claim pays.

Fees are current as of October 2026 and checked against the Schedule of Benefits (the fee schedule in force since April 1, 2026). Every code links to its page in our billing code reference, which shows the full Schedule text and fee history. If you are new to OHIP billing itself, start with how to bill OHIP and come back here for the codes.

The codes you will bill every week

Our family practice code set keeps these and the rest of the office codes on one page, with live fees.

The assessment ladder

Office assessments for family practice are the A00x block. The level is set by what the visit required, not by how long it took.

A few rules on this ladder cause most of the trouble.

A008 is not a short-visit code. The Schedule defines the mini assessment narrowly: it is billed for an unrelated non-WSIB problem during the same visit as a WSIB-related minor assessment (A001). A quick prescription renewal or a recheck is A001. A008 is not payable if a higher assessment is claimed for the non-WSIB part of the visit.

A003 has an annual limit. One general assessment per patient per physician per 12 months. The limit rises to two when the second is for a clearly different and unrelated diagnosis, or when at least 90 days have passed and the second is a hospital admission assessment. Extra general assessments are paid at a lesser assessment fee, not refused. A003 is not payable in the patient's home.

A004 is limited to two per 12 months per patient per physician, except when rendered as a hospital admission assessment. Beyond that it is also paid at a lesser fee.

Patients 65 and older add 15%. The Schedule's age premium raises A003, A004 and A007 by 15% for patients 65 and over, as well as K132, the hospital and LTC equivalents (C003, C004, W102, W109, W004) and the focused practice assessments. It is applied by OHIP; there is no separate code to add.

For a closer look at A007, including well baby care and the add-ons that ride on it, see the A007 code page.

Consultations and focused practice assessments

Family physicians also receive referrals. A consultation follows a written request from a physician or nurse practitioner and includes all the elements of a consultation, with a report back to the referring provider.

No other consultation, assessment, visit or counselling service is payable to the same patient the same day as A911 or A912.

Family physicians with additional training or experience in a focused area bill the focused practice assessments, each at $44.55 and each requiring at least an intermediate assessment: A917 sport medicine, A927 allergy, A937 pain management, A947 sleep medicine, A957 addiction medicine and A967 care of the elderly. No other assessment or counselling is payable the same day, and the smoking cessation add-on E079 is not payable with them.

Preventive care and periodic health visits

A periodic health visit is for a patient over two who presents with no apparent acute physical or mental illness. It includes an intermediate-level assessment with age- and gender-appropriate history, examination, screening and counselling.

The rules:

• One per patient per physician per 12 months. Periodic health visits beyond the limit are not insured, so they are not paid at a lesser fee the way an extra A003 is.
• Only one of K131, K132 or K133 per patient per physician per 12 months.
• No diagnostic code is required for periodic health visits unless one is listed. K133 is the exception: it is payable only for the listed conditions (OHIP diagnostic codes 299, 319, 343, 741 or 758), needs at least 50 minutes of direct contact in total, and at least 26 minutes of that in person.
• E089 is a percentage add-on of 20% on K131 or K132, for the patients listed in the table.

Screening and prevention add-ons

Cervical screening has tightened. For services from March 3, 2025 to March 31, 2028, G365 is limited to once per patient per 33 months, and it is uninsured for patients under 25. When the collection happens during a consultation, a general assessment or re-assessment, or a routine postnatal visit where the pelvic exam is a normal part of the service, G365 is not payable on top; bill E430 (or E431) alone as the add-on when you collect outside a hospital. E432 cannot be combined with E430 or E431.

E079 pays once per patient per 12 months and attaches to a long list of visits, including A001, A003, A004, A007, K013, the periodic health visits and the prenatal codes. K039 is payable up to twice in the 12 months after E079, by the same physician. Neither covers cannabis or vaping discussions.

Q150A and Q152A are listed in Appendix Q of the Schedule, which carries the primary care codes; the Ministry's eligibility details for them are in its bulletins.

Chronic disease management

Family physicians do not have access to the chronic disease assessment premium E078: the Schedule limits it to specialists in listed specialties such as geriatrics, endocrinology and neurology. Chronic disease work in family medicine is billed through dedicated codes instead.

Diabetes. K030 is payable to the most responsible physician and is capped at four per patient per 12 months. It is a standalone visit: if you bill another consultation or visit for the same patient on the same day, K030 is paid at nil, so choose one. Q040 is the annual incentive for planned diabetes care consistent with Diabetes Canada guidelines; it pays once per patient per 12 months and only after at least three K030 services in that same period. K029 is time-based support for patients on intensive insulin therapy (three or more injections a day, or a pump), with a maximum of six units per patient per year.

Shared appointments. K140 to K144 are for pre-scheduled group sessions with two to twelve patients who share a diagnosis of diabetes, heart failure, asthma, COPD, hypercholesterolemia or fibromyalgia. You submit a claim for each patient, using the code for the group size, up to eight units per patient per day. Each patient must regularly see you or your group for that disease.

Heart failure. Q050A is an Appendix Q incentive payable to physicians in the CCM, FHG, FHN, FHO and other listed primary care models.

K125 is payable only for the conditions listed in the Schedule (OHIP diagnostic codes 299, 319, 343, 741 or 758), and that diagnostic code must be on the claim.

Counselling and psychotherapy

Counselling, psychotherapy and primary mental health care are time-based. A unit is half an hour or major part of it, and the minimum direct contact for each number of units is fixed:

Under 20 minutes, the service is not counselling or psychotherapy at all; it is the assessment that fits what you did. Time spent on other separately billed services does not count.

The counselling rules that matter most:

1. The three-unit cap. K013 and K040 together pay at the higher fee for three units per patient per physician per 12 months. Units after that pay as K033 or K041. Plan longer courses of counselling with that in mind, or consider whether the work is really psychotherapy (K007) or primary mental health care (K005), which are not subject to the three-unit limit.
2. It must be pre-booked. Counselling without a pre-booked appointment is paid at a lesser assessment fee.
3. Almost nothing else pays the same day. On a counselling day, only a listed set of services is payable to the same physician: injections and immunizations, venipuncture, cervical screening, E080, K002, K003, K008, K014, K015, the forms K031, K035, K036 and K038, and a few others.
4. Psychotherapy and assessments on the same day need clearly different diagnoses, otherwise the psychotherapy is not payable.

K015 is claimed under the health number of the ill patient, not the relative.

Mental health and addictions

K005 covers assessment and treatment of mental illness or emotional problems with attention to biological and psychosocial functioning. It is not billed with another visit at the same encounter unless the diagnoses are clearly different.

K623 includes the history, examination, notifications and completing Form 1 under the Mental Health Act. K032 needs testing of memory, attention, language, visuospatial and executive function; the Schedule states that the Mini-Mental State Examination alone is not acceptable for it.

Forms and certificates

Several forms have their own fee codes. Some are insured services; others, in Appendix F, are paid by the Ministry of Health on behalf of other ministries. Either way, the listed fee is full payment, and you cannot charge the patient extra for them.

ODSP and Ontario Works forms:

The ministry forms are given to patients by social services staff, and each code is only for its own form.

Some limits on the insured forms: K070 is once per home care admission and not payable while the patient is already receiving home care. K071 is limited to one per patient per physician per week for the first 8 weeks; K072 to two per patient per physician per month after that. Neither is payable on the same day as a visit with the patient. K035 claims beyond one per 12 months for the same patient go in with the manual review indicator. K034 applies only to the diseases on the Schedule's immediate-report list.

Certification of death is paid at nil when it is done with a pronouncement of death (A902 at home, A777 elsewhere), because those codes include it.

Office procedures and the G700 rule

Procedures in the Diagnostic and Therapeutic Procedures section are payable in addition to an assessment unless the Schedule says otherwise. G700 is the one that catches people.

G700 ($8.80) is the basic fee-per-visit premium. Add it when a procedure marked (+) in the Schedule is the sole reason for the visit, once, however many (+) procedures you do. It is not payable:

• when you bill a consultation or assessment for the same patient the same day;
• in a hospital;
• when the (+) procedure itself is not payable;
• more than once per patient per day;
• where the physician has a financial interest in the facility where the service is rendered.

For a patient enrolled with a physician or group in a capitation-based model, G700 is paid at 15% of the listed fee.

Common (+) procedures in family practice:

Other office procedures (no G700):

Children get an age premium on surgical procedures. The Schedule increases surgical procedures in Parts K to Z, which include the Z-code office procedures above, by 30% for a newborn under 30 days, 25% from 30 days to one year, 20% from one to two years, 15% from two to five years and 10% from five to 16 years. A laceration repair on a three-year-old pays more than the listed fee without any extra code.

Immunizations and injections

Every immunization is marked (+). When the immunization is the only reason for the visit, add G700, once per patient per day. Two vaccines at an immunization-only visit is two immunization codes and one G700.

Non-vaccine injections work differently. G372 is the injection with a visit, and each additional injection; G373 is the first injection when it is the sole reason. G372 and G373 are not insured for vitamin injections given to facilitate weight loss.

The Schedule lets you delegate venipuncture, injections and immunizations, ear syringing and simple office lab tests to someone you employ, and still bill them. It does not pay for delegated services performed by someone employed by a hospital, public health unit, long-term care home or Family Health Team.

Prenatal care, postnatal care and well babies

P005 is billed by the most responsible physician for the initial review of antenatal risk. It is paid at nil if billed the same day as any other consultation or visit except P003 or P004, so the usual pattern is P005 together with P003 at the first visit. E079 attaches to P003, P004, P005 and P008, and E080 to P003, P004 and P008.

Well baby care for the first two years is an intermediate assessment (A007), with a complete examination, weight and measurements, and guidance for the parents. A002 is the enhanced 18-month visit for a child of 17 to 24 months: well baby care plus an 18-month developmental screen and a review with the parent of a brief standardized tool they complete, such as the Nipissing District Developmental Screen. From the second birthday, routine checks are K017.

Family physicians who deliver babies bill P006 for a vaginal delivery and P009 for attending labour and delivery in the role the Schedule describes. Physicians in an FHO also have the newborn care episodic fee Q015A ($13.99) from Appendix Q.

Palliative care and home visits

A900 is for a patient 65 or older with complex medical needs, cognitive impairment, reduced mobility or falls, or unexplained functional decline, or for a housebound patient of any age. It must meet at least the requirements of an intermediate assessment. It is paid for the first person seen at a location per visit (an apartment block or retirement home counts as one location), and it is payable in a retirement residence but not in a long-term care home.

K023 is time-based support for pain and symptom management, emotional support and counselling. No other family practice visit code is payable with it except A945, and units of K023 start counting 50 minutes after the A945 start time.

G512 pays once per patient per week (Monday to Sunday) to the most responsible physician for supervising palliative care in any location. K071 and K072 are not payable to anyone in a week G512 is billed, but assessments, W010, K023 and special visit premiums still are.

Home visits and premiums. A007 or A001 at the home includes travel and does not attract the Table VI home special visit premiums. Palliative home visits have their own Table VII premiums (B998, B997, B966), and the house call and special visit rules are set out in full in our special visit premiums guide.

Hospital and long-term care visits

Hospital in-patients (C-codes)

Subsequent visits are limited to one per patient per day for the first five weeks, three per week in weeks 6 to 13 and six per month after that. After five weeks, an acute intercurrent illness beyond those limits is C121. C122 and C123 are one each per admission and not payable on the day of discharge. C124 is once per admission, to the MRP, and is not payable when the patient leaves within 48 hours of admission or for transfers within the same hospital.

E082, E083 and E084 are percentage premiums on the MRP's own services. E082 is once per admission and only when the admitting physician is the MRP; only one of E083 or E084 is payable per patient per day; and all three depend on the hospital remuneration condition in the Schedule. See the hospital in-patient code set for the rest of the in-patient codes.

Long-term care (W-codes)

W010 is the code that organizes nursing home billing. It is payable once per patient per calendar month to the MRP when at least two W-prefix assessments were rendered that month. It includes almost everything else for the month: subsequent visits, admission assessments, the periodic health visit and re-assessment, palliative visits, routine injections, immunizations and venipuncture, home care forms, medication reviews, and weekday daytime calls from staff. Visits that qualify for a special visit premium, counselling or psychotherapy of 20 minutes or more, and physician-to-physician telephone consultations are not included.

If you have billed W010 for the patient in the previous 11 months, a month with two to four W-prefix assessments pays W010 only, a month with one pays only that assessment, and more than four lets you add W121 for the extra intercurrent illness visits. Age premiums on the component services are not paid on top of W010. Our long-term care code set lists the LTC special visit premiums as well.

Covering the emergency department

A family physician on an ED shift bills the H-prefix emergency department codes, not the A-codes. Those have their own time tiers and premiums, covered in our emergency medicine billing guide.

Virtual care

Family physicians with an existing relationship bill comprehensive virtual care using the in-person codes listed in Appendix J. Without one, only the limited virtual care codes apply:

The rules on what counts as an existing relationship, the modality indicators, and the video-only codes are in our virtual and telephone billing codes guide.

Premiums at a glance

E080 is only payable to the patient's primary care physician, with a listed set of services (including A001, A003, A004, A007, A900, K013, K030 and P003), and not when the admission was for day surgery, or for obstetrical delivery or newborn care unless the mother needed the ICU or the baby the NICU. Who qualifies for a special visit premium, the exclusions around routine office hours, and the tables for every setting are in our special visit premiums guide.

The full list, with the situations where each is missed, is in the OHIP premiums family physicians leave on the table.

Shadow billing in patient enrolment models

Many family physicians are paid mainly by capitation in a patient enrolment model such as a Family Health Organization (FHO) or Family Health Network (FHN). The codes in this guide do not change; what changes is how they are paid.

• Services in your model's capitation basket are shadow billed. You submit the same claims with the same codes, and they are paid at a reduced shadow rate rather than the full fee, so they still record the care you delivered. The Schedule itself tells physicians paid other than by fee-for-service to consult their contract for guidance on shadow billing, so the shadow rate and the basket list come from your agreement, not the Schedule.
• Services outside the basket are paid fee-for-service in full, which is why the code you choose still matters.
• Some rules are written for enrolled patients. G700 is paid at 15% when the patient is enrolled with a physician or group in a capitation-based model, whichever physician in the group does the procedure.
• Appendix Q lists the primary care codes that only exist in these models.

Appendix Q is published with the Schedule for information only, and it points to the Ministry's Primary Health Care fact sheets for the full requirements of each code. Treat those fact sheets and your agreement as the source for anything model-specific.

Mistakes that cost family physicians money

1. Using A008 for quick visits. It is the WSIB mixed-visit code. Short OHIP visits are A001.
2. Billing E078. Family physicians are not an eligible specialty. Use K030, Q040, K029 and K140 to K144.
3. Billing a visit and K030 together. K030 is then paid at nil. Pick the one that describes the visit.
4. Counselling without a booked appointment. It drops to a lesser assessment fee. So does a fourth unit of K013, to K033.
5. G700 with an assessment. If you assessed the patient, G700 is not payable; it is for visits where the (+) procedure was the only reason.
6. G365 on top of a general assessment where the pelvic exam is part of it. Bill E430 alone as the add-on.
7. Separate visits in a nursing home in a W010 month. Once W010 is billed, its component services are not payable to any physician that month.
8. A second periodic health visit inside 12 months. It is not insured, so it is not paid at all. If the patient needs to be seen, bill the assessment that fits the visit.

How SnapBill helps

SnapBill is built by physicians for Ontario billing. Photograph a whole day sheet or patient list and the claims are drafted for you, with the codes from this guide, and every claim is checked against the Schedule of Benefits before it is submitted: annual limits like A003 and K131, the K013 unit cap, G700 against same-day assessments, W010 months, and the diagnostic codes K125 and K133 need. Essentials is 0.2% of paid claims, capped at $34.99 a month plus HST; Premium is 1.5% of paid claims. Create a free account, or browse any code in the billing code reference.