The Most Common OHIP Billing Codes for Mental Health Care

As we face continued challenges and difficulties during the COVID-19 pandemic, physicians are seeing more patients for mental health consultations than ever before. We have put together a breakdown of the most common OHIP billing codes for mental health care including temporary virtual care codes that you can currently use for mental health consultations as well as common in-person codes.

We have broken down the post into five sections:

  1. Temporary OHIP Virtual Care Billing Codes
  2. Primary Mental Health Care Billing Code
  3. Psychotherapy OHIP Billing Codes  
  4. OHIP Billing Codes for Interviews and Counselling
  5. Application for Psychiatric Assessments

1. Temporary OHIP Virtual Care Billing Codes

As a result of the COVID-19 pandemic, the Ministry of Health introduced two specific codes that you can bill for a psychotherapy virtual care visit. These codes are temporary and will be available until September 30, 2021.

Fee Codes Description Value
K081 1. Intermediate assessment of a patient by telephone or video, or advice or information by telephone or video to a patient’s representative regarding health maintenance, diagnosis, treatment and/or prognosis, if the service lasts a minimum of 10 minutes; or 2. Psychotherapy, psychiatric or primary mental health care, counselling or interview conducted by telephone or video, if the service lasts a minimum of 10 minutes. $36.85
K082 Psychotherapy, psychiatric or primary mental health care counselling or Interview conducted by telephone or video per unit (unit means half hour or major part thereof) $67.75

Some things to note

  • Services must be documented on the patient’s medical record (including the start and stop times) or the service is not eligible for payments.
  • Codes are insured when the service was initiated by the patient or the patient’s representative and the service is personally rendered by the physician.
  • Codes will not contribute to the Fee-For-Service Hard Cap.

For a comprehensive guide to OHIP billing codes for virtual care and COVID-19, visit our blog here.

2. 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) $67.75

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) $67.75
K019 Psychotherapy – Group of 2 (per unit) $33.90
K020 Psychotherapy – Group of 3 (per unit) $22.55
K012 Psychotherapy – Group of 4 (per unit) $17.05
K024 Psychotherapy – Group of 5 (per unit) $14.05
K025 Psychotherapy – Group of 6 to 12 (per unit) $11.95
K004 Psychotherapy – 2 or more family members (per unit) $10.80

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 $67.75
K013 Counselling – Individual Care – first three units of K013 and K040 combined per patient per provider per 12-month period (per unit) S67.75
K033 Counselling – Individual Care – additional units per patient per provider per 12-month period (per unit) $47.70
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) $67.75

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 $113.35

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!


 

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