Knowing which fee codes are available within your specialty is an important aspect of billing correctly. It’s not uncommon for family physicians to undercode simply because they aren’t aware of what they can use.
In an attempt to make things easier, we’ve created a cheat sheet that lists all of the OHIP fee codes available for Family Physicians working in a long care facility.
Remember to bookmark this page for a quick reference to Family Practice OHIP Billing Codes. For a printable PDF scroll to the bottom.
Family Practice Guidelines for Consultations & Assessments
Consultations are allowed 1 per 12-month period.
- Requirements: written request from a referring physician or nurse practitioner.
- ***2nd Consultation is payable in a 12-month period if the diagnosis is completely different than the first.
Repeat Consultations are allowed 1 per 12-month period, following a consultation pertaining to the same diagnosis.
- Requirements: written request from a referring physician or nurse practitioner.
Limited Consultations are allowed 1 per 12-month period.
- Requirements: written request from a referring physician or nurse practitioner.
General Assessments are allowed 1 per 12-month period.
- Requirements: less time spent with the patient than a consultation.
General Re-assessments are allowed 2 per 12-month period.
- Partial Assessments are unlimited.
Family Practice OHIP Billing codes for Consultations & Assessments
W105 Consultation
W911 Special family consultation
- Minimum of 50 minutes direct contact with patient.
W912 Comprehensive family consultation
- Minimum of 75 minutes direct contact with patient.
W106 Repeat consultation
Long Term Care Facility: Special Visit Premium
**When using a premium for time and travel make sure the consult/assessment is the prefix A:
| Weekdays | Mon. – Fri. “Sacrifice of Office hours” | Evenings Mon. – Fri. | Weekends & Holidays | Nights | |
|---|---|---|---|---|---|
| Travel Premium | W960 : $36.40 Max. 2 | W961 : $36.40 Max. 2 | W962 : $36.40 Max. 2 | W963 : $36.40 Max. 6 | W964 : $36.40 Unlimited |
| First Person Seen | W990 : $20.00 Max. 1 | W992 : $40.00 Max. 1 | W994 : $60.00 Max. 1 | W998 : $75.00 Max. 1 | W996 : $100.00 Unlimited |
| Additonal Person(s) Seen | W991: $20.00 Max. 9 | W993: $40.00 Max. 9 | W995: $60.00 Max. 9 | W999: $75.00 Max. 19 | W997: $100.00 Unlimited |
Family Practice OHIP Billing codes for Admission Assessment
W102 Type 1 – day of admission
W104 Type 2 – day 2 of admission
W107 Type 3 – day 3 of admission
W109 Periodic Health Visit
W777 Intermediate assessment, pronouncement of death.
W771 Certification of death
W004 General re-assessment
- May be claimed 6 months after W109.
W903 Pre-dental/pre-operative general assessment
- Maximum 2 per 12 month period.
W904 Pre-dental/pre-operative assessment
Family Practice OHIP Billing codes for Subsequent Visits
Chronic Care of Convalescent hospital
W002 First 4 subsequent visits per patient per month.
W001 Additional subsequent visits
- Maximum 4 per patient per month.
W882 Palliative care
W121 Additional visits due to intercurrent illness
W010 Monthly Management
- Minimum 2 assessments per patient per month.
Family Practice OHIP Billing codes for Counselling (calculated in ½ hour increments)
***if billed with a consultation/assessment or visits the diagnosis must be different for the first service.
K002 Primary mental health care
K013 Individual care (first 3 units of K013, K040 combined per patient per 12 month period).
K033 Additional units per patient per 12 month period
Family Practice OHIP Billing Codes for Group Counselling
K040 2 or more persons (where no group members have received more than 3 units of any counselling per 12 month period).
K041 Additional units
K014 Transplant recipients, donors or families of recipients and donors.
K015 Relatives of catastrophically or terminally ill patients.
Case Conference
K124 Long Term Care/CCAC case conference
K705 Long Term Care high risk patient conference
- Maximum 4 services per patient per physician per 12 month period.
- Maximum 8 units per patient per physician per 12 month period.
Case Conference Units
| # Units | Minimum time |
|---|---|
| 1 unit | 10 minutes |
| 2 units | 16 minutes |
| 3 units | 26 minutes |
| 4 units | 36 minutes |
| 5 units | 46 minutes |
| 6 units | 56 minutes |
| 7 units | 66 minutes |
| 8 units | 76 minutes |
Telephone Consultations
K730 Physician to Physician telephone consultation – referring physician.
K731 Physician to Physician telephone consultation – consultant.
Common Billing Mistake: Getting rejections on Counselling Codes
We often see rejections of counselling codes due to the following reasons:
1. Billing special visit premiums on counselling codes.
2. Billing counselling (such as K013) on the same bill as an assessment with the same diagnosis code.
Counselling appointments are technically pre-booked and therefore no special visit premiums apply.
However, counselling codes CAN be billed on the same day as an assessment BUT:
- They need to be on separate claims.
- They need to have different and unrelated diagnostic codes.
*** With the exception of the codes listed below, no other services are eligible for payment when rendered by the same physician on the same day as any type of counselling service.
Exceptions:
E080
Family Practice OHIP Billing Codes
‘Cheat Sheet’
Downloadable PDF file
If you’re interested in the most commonly used Family Practice OHIP billing codes, make sure to save a link to our OHIP searchable database below.
If you don’t see the code you’re looking for just search for it on the right hand side under
“Find any billing code.”
Family Practice OHIP billing codes Searchable Database
Final Takeaway:
Remember you have the option of ” starring” your most commonly used billing codes. Using this feature will help save you time as your most commonly used billing codes will appear at the top of your lists so you can find them easier.
Contact us if you have any questions regarding Family Fee Codes.
Looking to maximize your billing?
Check out The Ultimate OHIP Billing Guide for more tips, tricks and automated features!
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
Search All OHIP Billing Codes
Search the Ontario Schedule of Medical Benefits electronically. We’ve digitized all the OHIP billing codes so you can easily find the most up to date billing rules and amounts.
