Top 20 OHIP Billing Codes Every Family Physician Should Know

Family medicine accounts for the largest volume of OHIP claims in Ontario. Whether you're a new graduate or a seasoned physician optimizing your billing, knowing these 20 codes inside and out will cover the vast majority of your day-to-day practice.

All fees shown are current as of the April 2026 Schedule of Benefits update.

Core Visit Codes

These are the codes you'll bill most often — the backbone of any family practice.

A003 — General Assessment ($95.60)

The highest-paying standard visit code. Use A003 for a comprehensive assessment including a complete history, full examination, and management plan. This is your go-to for new patients, complex presentations, or annual physicals that go beyond a routine check-up.

Tip: A003 requires documentation of a complete history and full physical exam. If you only examine the relevant system, bill A007 instead.

A004 — General Re-Assessment ($39.35)

For follow-up visits where a comprehensive reassessment is needed. Use when a patient returns for ongoing management of multiple conditions requiring a complete review.

A007 — Intermediate Assessment ($44.55)

Your workhorse code. Use for visits requiring examination of the affected system(s) to make a diagnosis or assess function. Also covers well baby visits for children under 2 years.

Common mistake: Don't bill A007 for simple follow-ups of stable conditions — that's A008 territory.

A008 — Mini Assessment ($13.40)

For brief visits — prescription renewals, reviewing a single stable condition, or a quick check on a recovering patient. Low-paying but legitimate when the visit truly is minor.

A001 — Minor Assessment

Similar to A007 but for simpler presentations requiring only a focused examination of the presenting complaint.

Preventive Health Visits

Periodic health visits are some of the best-paying codes in family medicine and are often under-billed.

K131 — Adult Periodic Health Visit ($64.25)

Annual physical for patients aged 18–64. Requires a complete examination, health risk assessment, and counselling. This is separate from any visit for an active complaint.

K130 — Adolescent Periodic Health Visit ($87.10)

For patients under 18. Higher fee than K131 because of the additional developmental assessment components.

K017 — Child Periodic Health Visit ($49.55)

Routine check-ups for children after age 2 (well baby visits under 2 use A007).

Premiums That Add Up

Premium codes are where many physicians leave money on the table. These are add-ons to your base visit codes.

E078 — Chronic Disease Assessment Premium

Billable when assessing a patient with a qualifying chronic condition (diabetes, CHF, COPD, etc.). This premium is frequently missed — review your patient roster for eligible conditions.

E400 — After-Hours Premium (Evenings/Weekends)

50% premium on eligible visit fees for services rendered after hours (17:00–24:00 weekdays, weekends, and holidays). If you see patients in the evening, this adds significantly to your revenue.

E401 — Night Premium

75% premium for services between 00:00 and 07:00. Night calls are rare in family medicine but well-compensated when they happen.

B993 — Special Visit Premium ($84.80)

For urgent house calls or nursing home visits outside regular hours. One of the highest-value premiums available.

K998 — First Person Seen ($77.10)

Premium for the first patient seen in an emergency department encounter. Often applicable for FPs doing ER coverage.

Procedural & Injection Codes

Don't forget to bill separately for procedures done during a visit.

G372 — Injection With Visit ($4.55)

For IM, SC, or intradermal injections performed during a visit. Small amount per injection but adds up across a busy flu season or vaccination clinic.

G373 — Injection as Sole Reason ($7.90)

When the injection is the only reason for the visit (e.g., a patient coming in solely for a flu shot or B12 injection).

G365 — Cervical Cancer Screening ($12.00)

Collection of cervical cancer screening specimens. Bill separately from the visit code.

G489 — Venipuncture ($3.54)

Blood draw performed in your office. Billable in addition to the visit code.

Special Populations

A945 — Palliative Care Consultation ($174.25)

The highest-paying consultation code. For initial palliative care assessments — requires a comprehensive evaluation and care plan.

K013 — Counselling ($80.00)

Individual counselling or psychotherapy. 30-minute minimum, with documentation of the counselling provided.

K023 — Palliative Care Support ($85.25)

Ongoing palliative care management. Complements A945 for follow-up visits with palliative patients.

Maximizing Your Billing

1. Always check for eligible premiums: After-hours, chronic disease, and age-based premiums are the most commonly missed add-ons
2. Document thoroughly: The difference between A003 ($95.60) and A007 ($44.55) is your documentation — a complete history and full exam justifies the higher code
3. Use the right code, every time: Under-coding is just as problematic as over-coding. Bill what you do.
4. Stay current on fee changes: The Schedule of Benefits updates regularly. The April 2026 update brought significant increases to core visit codes
5. Look up unfamiliar codes: Use our billing code reference to check fees, restrictions, and related codes before submitting

Quick Reference Table

| Code | Description | Fee | |------|-------------|-----| | A003 | General assessment | $95.60 | | A004 | General re-assessment | $39.35 | | A007 | Intermediate assessment | $44.55 | | A008 | Mini assessment | $13.40 | | K131 | Adult periodic health visit | $64.25 | | K130 | Adolescent periodic health visit | $87.10 | | K017 | Child periodic health visit | $49.55 | | K013 | Counselling | $80.00 | | A945 | Palliative care consultation | $174.25 | | K023 | Palliative care support | $85.25 | | E078 | Chronic disease premium | Variable | | E400 | After-hours premium | +50% | | E401 | Night premium | +75% | | B993 | Special visit premium | $84.80 | | K998 | First person seen | $77.10 | | G372 | Injection with visit | $4.55 | | G373 | Injection sole reason | $7.90 | | G365 | Cervical screening | $12.00 | | G489 | Venipuncture | $3.54 | | G590 | Influenza vaccination | $8.80 |

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Want to look up any OHIP billing code instantly? Browse our complete billing code reference — updated with every Schedule of Benefits release.