As we face continued challenges and difficulties following the COVID-19 pandemic, physicians continue to see a significant number of patients for mental health consultations. This blog provides a comprehensive breakdown of the most common OHIP billing codes for mental health care.
We have broken down the post into four sections:
- Primary Mental Health Care Billing Code
- Psychotherapy OHIP Billing Codes
- OHIP Billing Codes for Interviews and Counselling
- Application for Psychiatric Assessments
1. Primary Mental Health Care Billing Code
The primary code for mental health visits is the K005 code for individual care. This code is payable for visits where physicians provide advice and information with respect to diagnosis, treatment, health maintenance, and prevention. It is a time-based code that requires a minimum of 20 minutes of direct patient contact.
| Fee Codes | Description | Value |
| K005 | Primary mental health care – individual care (per unit) | $70.10 |
Some things to note:
- A unit means a half hour or major part thereof.
- The code is not payable in conjunction with other consultations and visits rendered by a physician during the same patient visit unless there are clearly different diagnoses for the two services.
- For example, if a patient comes in to discuss their anxiety for 20 minutes and then discusses symptoms of a fever unrelated to the anxiety, you can bill the intermediate assessment (A007) with the K005 fee code.
3. Psychotherapy OHIP Billing Codes
Psychotherapy includes narcoanalysis or psychoanalysis or treatment of sexual dysfunction. There are seven codes available for billing this service. Like the K005 code, it is a time-based code that requires a minimum of 20 minutes.
| Fee Codes | Description | Value |
| K007 | Psychotherapy – Individual care (per unit) | $70.10 |
| K019 | Psychotherapy – Group of 2 (per unit) | $35.10 |
| K020 | Psychotherapy – Group of 3 (per unit) | $23.35 |
| K012 | Psychotherapy – Group of 4 (per unit) | $17.65 |
| K024 | Psychotherapy – Group of 5 (per unit) | $14.55 |
| K025 | Psychotherapy – Group of 6 to 12 (per unit) | $12.35 |
| K010 | Additional units per member | $11.20 |
| K004 | Psychotherapy – 2 or more family members (per unit) | $76.10 |
Some things to note:
- A unit means a half hour or major part thereof.
- This code may not be claimed as such when provided in conjunction with a consultation or other assessment rendered by a physician during the same patient visit unless there are clearly defined different diagnoses for the two services.
- For example, if a patient comes in to discuss their mental health concerns for 20 minutes and then discusses symptoms of a cough unrelated to the mental health concerns, you can bill the intermediate assessment (A007) with the appropriate fee code.
4. OHIP Billing Codes Interviews and Counselling
There are four codes available for billing interviews and counselling. The K008 fee code is billed for services provided for a child and/or parent while the others are general codes for counselling individuals and groups.
| Fee Codes | Description | Value |
| K008 | Diagnostic interview and/or counselling with child and/or parent for psychological problem or learning disabilities | $70.10 |
| K013 | Counselling – Individual Care – first three units of K013 and K040 combined per patient per provider per 12-month period (per unit) | S70.10 |
| K033 | Counselling – Individual Care – additional units per patient per provider per 12-month period (per unit) | $49.35 |
| K040 | Group counselling – 2 or more persons, where no group members have received more than 3 unites of any counselling paid under codes K013 and K040 combined per provider per 12-month period (per unit) | $70.10 |
| K041 | Group counselling – 2 or more persons, additional units where any group member has received 3 or more units of any counselling paid under codes K013 and K040 combined per provider per 12-month period (per unit) | $50.20 |
Some things to note:
- A unit means a half hour or major part thereof.
- The code K008 is claimed using the child’s health number. Psychological testing is not an insured service.
5. Application for Psychiatric Assessment
For a patient to receive a psychiatric assessment, a physician must fill out the Form 1 application. The application for psychiatric assessment in accordance with the Mental Health Act includes:
- Necessary history
- Examination
- Notification of the patient, family, and relevant authorities
- Completion of form.
| Fee Code | Description | Value |
| K623 | Application for psychiatric assessment – Form 1 | $117.05 |
We have created a quick reference guide for the mental health billing codes. You can download it here.
Need further assistance with billing for mental health visits or correcting billing errors? We can help!
