Ontario Family Medicine Billing Guide

General Assessments Counselling Periodic Health Exam

No diagnostic code necessary
A001 Minor Assessment $23.75
K005 Primary Mental Health Care $67.75
K017 Child (2-15) $43.60

A007 Intermediate Assessment

$36.85
K007 Psychotherapy $67.75
K130 Adolescent (16-17) $77.20

Minor Assessment K013 Educational Counselling $67.75

K131 Adult (18-64 inclusive) $54.00

+ Q015 <12 mo (max 8) $13.99

K033 Use if already billed 3 K013)/yr

$67.75
K132 Adult (65 and older) $77.20

A003 General Assessment $84.45

- two per patient/year. In-person. K002 Interview with Family $67.75

A002 18 Month Visit (17-24mo) $62.20

K028 STD Counselling $67.75
Rostering Codes
- need WBV, Rourke, Nipissing A680 Substance Use Consult $144.75
Q200
FHO Rostering

Q888 UCC Sat/Sun/Holiday $36.85

- 50 min assessment
Q023
From Hospital
$150

A888 ED Equivalent $36.85

K680 Substance Use Follow-up $67.75

Q043
Abnormal Risk CRC
$150-$230

- Add Q012
- Sat/Sun/Hol/Dec 25 - 31;
K071 Acute Homecare Supervision $21.40
Q053
HCC Complex $350

all visits need A888 that day

A005 GP Consultation K072 Chronic Homecare Supervision$21.40

De-Rostering
Q401 --  Q402 -- Q403 

$84.45

- need referring MD Smoking Cessation (MRP only)

Chronic Illness Codes E079 Initial Visit (1 per 12 months) $15.55
Vaccines/Injections
K030 DM Management (max 4x/yr) $40.55
- Bill with A/K codes; use flowsheet
G590 Flu shot
- add Q040 1/year (need 3xK030)        $60/year
K039 Follow-up visit (2/ 12 months) $33.45

Q590 Flu sole reason (FHO)

K029 Insulin Therapy Support $67.75
- Bill with A/K codes; use flow sheet
Q042 Counselling Fee $7.50
G538 Other: Hep A, Twinrix,

K032 Neurocog Assessment $67.75

- Bill with K039, subsequent to E079

MMRV, Men B, Pneumovax,

- MoCA only, MD only

K037 Fibromyalgia/Chronic Fatigue $67.75
Tdap-IPV, Td, Zostavax 
Serious Mental Illness
- for any visit, regardless of reason need min 5-9 pts = $1000
G840 DTaP-IPV (Quadracel)
Q020 Bipolar
K022 HIV Primary Care $67.75
10+ pts = $2000
G841 DTaP-IPV-Hib (Pediacel)
Q021 Schizophrenia Bill all Q020/Q021 April 1st. 

K023 Palliative Care/Home Visit $72.15

G842 Hep B (Engerix)
Q050 Heart Failure Incentive Fee $125
G843 HPV
- once yearly; eligible with Q012 Virtual Care G844 Men C (Menjugate)
Home Visits + Palliative Visits K300 Video A101 Limited Video $20.00
G845 MMR (Priorix)
A900 Complex Elderly/Homebound $45.15
K301 Telephone A102 Limited Telephone $15.00
G846 Prevnar-13
B960 Travel Premium
$36.40
G847 Tdap (Adacel, Boostrix)
B990 First Patient Seen Premium $27.50
Forms G848 Varicella (Varivax)
K034 Reportable Dz $36.00
Inections (allergy, joint, bursa)
B966 Palliative Travel Premium
$36.40
K035 MTO Mandatory $36.25

B998 First Patient Seen Premium $82.50

K036 Northern Travel Grant G202 Allergy Inj (max 2) $4.45

$10.25

K038 LTC Application $45.15

G212 Allergy Inj, sole
$9.75

K050 MCFSC HSR & ADL Form $103.55

- add G202 x1 if > 1 inj

G372 Inj (IM, SC, ID) w/ visit $3.89

Perinatal Care K051 Health Status Report (HSR) $82.85

K052 ADL Form $20.70

G373 Inj (sole reason), first $6.75

P005 Antenatal Assessment $45.15

- add G372 for each additional inj
- bill once with either P004/P003 K053 OW Form $15.55

Special Necessities Form G375 ≥3 Lesion steroid inj

$8.85

P004 Routine Prenatal Visit $36.85

K054 $25.90

Joint, Bursa, Ganglion $20.25

P003 Full Hx + Exam (1/ preg) $77.20

K055 Special Diet $20.70
+# G370
K056 Pregnancy Allowance G371 Subsequent Inj (max 5) $19.90

P008 Post-natal Care Office $36.85

$20.70

G328 Aspiration +/- inj $39.80

- P codes not eligible with Q012 after hours K623 Form 1 + 42 $113.35
+
A920 Early Preg Medical Mgmt $161.15
CCAC/Home Care add    G329  additional joint (max 2)
$20.25
K070 $31.75

Office Procedures Face/Neck Other

Malignant Pre-Malignant

E542 Tray Fee (#) $11.55

+ G420 Ear syringe/curette $11.35

G005 Pregnancy Test $3.88

G403 Epley $21.15
1 R160 $53.20 R163 $43.60
G010 Urinalysis $2.14
$25.75
2 R161 $87.40 R164 $71.80
# Z101 I&D Abscess/Hematoma
G014 Rapid Strep Swab $5.70
Z173 2 Abscess ($30.85); Z174 ≥3 ($40.80)
≥3 R162 $174.75 R165 $143.55
+ Z117 Cryotherapy $11.65
# Z104 I&D Perianal $20.10
Face/Neck Other
+ Z119 LN2 to 5 or more AK $29.00
# Z106 I&D Pilonidal Abscess $44.35

1 R048 $92.15 R094 $58.15

Dx code = 232, only for plantar, perianal, genital warts, all # Z113 Skin Bx (no sutures) $29.60

warts if immunocomp, warts, HEENT warts < 18 yo

2 R049 $139.20 R040 $95.70
# Z116 Skin Bx (suture) $29.60

# Z770 Endometrial Bx ≥3 R050 $233.00 R041 $191.40

$34.05
# + Z114 FB Removal w/ local $25.25
Bill in addition to A/K codes 

# G378 IUD Insertion $31.10

# Z128 Nail Resection $33.10
+ G700 if sole reason

Colon CA Preventative Tracking Codes Other Legend

Q150 FIT Counselling $7.00
Pap Screens Q012 After Hours Premium 30%
    +  G700 (sole) 
Q133/Q142 Tracking/exclusion (50-74) G365  +     E430 $8.65 +
$11.95
E080 1st visit <14d post d/c $25.25
    #  E542 (tray fee)
Mammogram Pap (every 33 months, 21 - 69) K730 Call consultant (>10min) $31.35
Time-based
Q131/Q141 Tracking/exclusion (50-74) G394 + E431 $8.65 +
$11.95
K734 Call ED doc (>10min) $31.35
Out-of-basket
Influenza If previous abnormal K738 e-consult $16.00

Q130 Tracking code (> 64 yo) Q011/Q140 Tracking/exclusion (21-69) G271 INR (monthly) $12.75
Dan Cojocaru, MD

December 2022

Additional Notes/FAQ
K005 - you can bill an A001 or A007 with a K005 mental health visit if they have separate complaints in addition to their mental health (i.e. cough and depression).
Document start/stop time for both issues. Consider submitting for manual review. You cannot bill A007 + K013 on same day.

K301 - Telephone visits are paid at 85% of corresponding in-person fee except for mental health visits K007, K005 (paid at 95%)

K029 (Insulin Therapy Support) - Counselling for patients requiring insulin injections 3x/day or infusion pump. Includes training for patients on insulin who use 
devices such as glucose meters, insulin pumps and insulin pens when rendered by the physician claiming K029. Out of basket.

K034 (Reportable Disease) - K034 is only eligible for payment for the following specified reportable diseases: anthrax, botulism, brucellosis, cholera, 
cryptosporidiosis, cyclosporiasis, diphtheria, primary viral encephalitis, food poisoning (all causes), symptomatic giardiasis, invasive haemophilus 
influenzae b disease, hantavirus pulmonary syndrome, hemorrhagic fevers (e.g. ebola, marburg and other viral causes), hepatitis A, lassa fever, 
legionellosis, listeriosis, measles, acute bacterial meningitis, invasive meningococcal disease, paratyphoid fever, plague, acute poliomyelitis, 
Q fever, rabies, rubella, Severe Acute Respiratory Syndrome (SARS), shigellosis, smallpox, invasive group A streptococcal infections, tularemia, 
typhoid fever, verotoxin-producing E. coli infection indicator conditions (e.g. haemolytic-uremic syndrome), west Nile virus illness, and yellow fever.

K071/K072 - K071 is a service rendered by a physician for personally providing medical advice, direction or information to health care staff of a CCAC or
CCAC contractor on behalf of a patient for whom the physician provides on-going medical care (first 8 weeks following admission to home care program). 
The K072 is the same as K071 but applies to after the 8th week following admission
to home care program.
Preventative Care Billing
% Fee
Category Code
E080 (video only), E079, Q050, K030 - can be billed with K300/K301 virtual consults. E080 rules: no day Sx, no 
60 $220 Q100A
OB/neonate unless ICU/NICU, (in-person/video only)
65 $440 Q101A
Influenza Vaccine
70 $770 Q102A
Q012/Q016 Codes Apply To: A001, A003, K017, K130, K131, K132, A004, A007, A008, A888, Q888, K005,  (patients ≥ 65)
K013, K030, K033, Q050.  75 $1100 Q103A
80 $2200 Q104A
Prenatal Billing - P005 is billed at the first prenatal visit only, also known as the antenatal preventative  60 $220 Q105A
assessment, require to complete Ontario Perinatal Record. P004 is a minor prenatal assessment (think of it as  65 $440 Q106A
Pap Smear (patients
an A007 equivalent). P003 is a general prenatal assessment (think of it as an A003 equivalent). P008 may be  21-69 yrs inclusive)
70 $770 Q107A
billed up to 12 months post-partum, for postpatrum issues only (e.g. bleeding, cramping, breast feeding, mood).  75 $1320 Q108A
All out-of-basket. 80 $2200 Q109A
55 $220 Q110A
A920 (Medical Management of Early Pregnancy) - Billed when physician renders an initial assessment and  Mammography 60 $440 Q111A
administers or gives a cytotoxic medication for early pregnancy termination or missed abortion. You cannot bill  (patients 50-74 yrs 65 $770 Q112A
another code for this patient (i.e. cannot bill A007 for assessment or K013 for counselling in addition to A920). inclusive) 70 $1320 Q113A
75 $2200 Q114A
Medical Form Codes (e.g. K035) do not need to be billed on the same day that you saw the patient or complete  85
$440 Q115A
Childhood
the form. They can be billed on any day.
Immunization (30-42 90 $1100 Q116A
months) 95 $2200 Q117A
Access bonus is 18.95% of your billings each month. Any patient seen outside your group are deducted dollar 
15 $220 Q118A
for dollar.

20 $440 Q119A
CRC Screening
Home/Palliative Visit Rules  - frail elderly patient, housebound patient, or palliative (document in chart). Bill  40 $1100 Q120A
(patients 50-74 years
with Travel + First Person Seen Premium. If you see a certain number of A900/palliative per year, you will receive inclusive) 50 $2200 Q121A
a bonus payment ranging from $1500-$8000.  60 $3300 Q122A
A frail elderly patient is: 70 $4000 Q123A
- 65 years of age or older and has one or more of the following
- complex medical management needs that may include polypharmacy Time Based Codes
- cognitive impairment (such as dementia or delirium); age-related reduced mobility or falls; or unexplained functional decline  Units Time
(not otherwise described above).
1 20 min
A housebound patient is a person:
- that has difficulty in accessing office-based primary health care services because of medical, physical, cognitive, or psychosocial  2 46 min
needs/conditions; 3 76 min [1 hr 16 min]
- transportation is not available or not appropriate in the person’s circumstances
- other strategies to address the access challenges have been considered but are not available or not appropriate in the person’s  4 106 min [1 hr 46 min]
circumstances 5 136 min [2 hr 16 min]
- for whom the care and support requirements can be effectively and appropriately delivered at home.

FHN/FHG Differences Notes

- After Hours Fee: Q012 (FHG, FHN, FHO); Q016 (CCM)
- Episodic Newborn Care: Q015 (FHO); Q015 (FHN)

Long-Term Care Special Premium: ≥12 patients served = $2000; ≥12 patients served = $5000 annual bonus 
(W010, W102, W002, W008, W121, W003, W001, W107, W777, W903, W004, W104)   

Prenatal Care Special Premium: ≥5 enrolled FHO patients (only) during 1st 28 wks = $2000 ((P003 and/or 
P004)   
 
Home Visits (Other than Palliative Care) Special Premium: ≥3 patients + ≥ 12 encounters = $1500; 
≥6 patients + ≥ 24 encounters = $3000;
≥17 patients + ≥ 68 encounters = $5000; ≥32 patients + ≥ 128 encounters = $8000; 
 
Palliative Care Special Premium: ≥4 patients $2000; ≥10 patients $5000 (K023, C882, A945, C945, W882, 
W872, B998)

Labour & Delivery Special Premium: ≥5 patients $5000; ≥23 patients $8000 (P006, P007, P009, P018, P020)

MOH Service Support Contact Centre

1-800-262-6524

[email protected]