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OHIP Billing Codes for Psychiatry: Cheat Sheet

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OHIP Billing Codes for Psychiatry

Consultation

A195   Consultation

A895   Consultation in association with special visit to a hospital inpatient, long term care inpatient or emergency department patient.

A395   Limited Consultation

A196   Repeat Consultation

*Please refer to the SoB page GP 17-19 for the detailed Consultation payment rules.

 

Other Consultation

A190   Special Psychiatric Consultation (required time spend a minimum of 75 minutes of direct contact with patient).

A795   Geriatric Psychiatric Consultation patient of 75 years or older, minimum of 75 minutes of direct contact with patients and must be scheduled a minimum of 24 hours prior to visit.

A695   Neurodevelopmental Consultation patient with complex neurodevelopment conditions e.g.: autism, global developmental disorders etc. Minimum of 90 minutes of direct contact with the patient.

  • Stop and start times must be recorded in medical record. Maximum 1 per patient per physician every 5 years.

 

Assessments and Interviews

Assessments

A193   Specific Assessment 

A194   Partial Assessment

 

Interviews

A197   Consultative interview with parent(s) or patient representative less than 22 years

A198   Consultative interview with a patient less than 22 years

A191   Consultative interview with caregiver(s) of a patient at least 65 years or a patient less and 64 years with a diagnosis of dementia

A192   Consultative interview with patient of 64 years or a patient less than 64 years with a diagnosis of dementia.

**Note: A191, A192, A197, A198 are not eligible for payment for the same patient, same day as family psychiatric care or family psychotherapy (K191, K193, K195, K196)

 

K630   Psychiatric Consultation Extension: per unit (1/2 hour + 1 unit), limited to a maximum of 6 units per patient per physician per day.

Consultation

Minimum time with the patient before the start time for the first unit of K630

Minimum time required for consultation service + 1 unit of K630 to be payable

[Commentary: Minimum time required for consultation service + 2 units of K630 to be payable

A190, C190, W190

90 minutes

106 minutes

136 minutes

A195

60 min

76 min

106 min

A197 – sole service

60 min

76 min

106 min

A198 – sole service

60 min

76 min

106 min

A197 + A198 same patient same day

120 min

136 min

166 min

A695, C695, W695

120 min

136 min

166 min

A795, C795, W795

90 min

106 min

136 min

A895, C895, W895

60 min

76 min

106 min

A191

60 min

76 min

106 min

A192

60 min

76 min

106 min

A191+ A192 same patient same day

120 min

136 minutes

166 min

 

Special Visit Premiums (Emergency Department)

*When billing Special Visit Premiums, use A-prefix consultation or assessment.

Not eligible for payment to Emergency Department Physicians (see definition GP67)

Premium

Weekdays Daytime (07:00- 17:00)

Weekdays Daytime (07:00 - 17:00) with Sacrifice of Office Hours

Evenings (17:00- 24:00) Monday through Friday

Sat., Sun. and Holidays (07:00- 24:00)

Nights (00:00- 07:00)

Travel Premium

$36.40 

K960 (max. 2 per time period)

$36.40 

K961 (max. 2 per time period)

$36.40 

K962 (max. 2 per time period)

$36.40 

K963 (max. 6 per time period)

$36.40 

K964 (no max. per time period)

First Person Seen

$20.00 

K990 (max. 10 (total of first and additional person seen) per time period)

$40.00 

K992 (max. 10 (total of first and additional person seen) per time period)

$60.00 

K994 (max. 10 (total of first and additional person seen) per time period)

$75.00 

K998 (max. 20 (total of first and additional person seen) per time period)

$100.00 

K996 (no max. per time period)

Additional Person(s) seen

$20.00 

K991 (max. 10 (total of first and additional person seen) per time period)

$40.00 

K993 (max. 10 (total of first and additional person seen) per time period)

$60.00 

K995 (max. 10 (total of first and additional person seen) per time period)

$75.00

 K999 (max. 20 (total of first and additional person seen) per time period)

$100.00 

K997 (no max. per time period)

 

* Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.

 

Special Visit Premiums (In-Patient)

*When billing Special Visit Premiums, use A-prefix consultation or assessment.

The “C” prefix consult codes are strictly for non-emergency inpatient consults (and therefore no special visits apply).

Premium

Weekdays Daytime (07:00- 17:00)

Weekdays Daytime (07:00 - 17:00) with Sacrifice of Office Hours

Evenings (17:00- 24:00) Monday through Friday

Sat., Sun. and Holidays (07:00- 24:00)

Nights (00:00- 07:00)

Travel Premium

$36.40
C960
(max. 2 per
time period)

$36.40
C961
(max. 2 per
time period)

$36.40
C962
(max. 2 per
time period)

$36.40 

C963 (max. 6 per time period)

$36.40
C964
(no max. per
time period)

First Person Seen

$20.00
C990
(max. 10
(total of first
and additional
person seen)
per time
period)

$40.00
C992
(max. 10
(total of first
and additional
person seen)
per time
period)

$60.00
C994
(max. 10
(total of first
and additional
person seen)
per time
period)

$75.00
C986
(max. 20
(total of first
and additional
person seen)
per time
period)

$100.00
C996
(no max. per
time period)

Additional Person(s) seen

$20.00
C991
(max. 10
(total of first
and additional
person seen)
per time
period)

$40.00
C993
(max. 10
(total of first
and additional
person seen)
per time
period)

$60.00
C995
(max. 10
(total of first
and additional
person seen)
per time
period)

$75.00
C987
(max. 20
(total of first
and additional
person seen)
per time
period)

$100.00
C997
(no max. per
time period)

 * Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.

 

In-Patient Services 

C895   Consultation

C190   Special Psychiatric Consultation

C395   Limited Consultation

C196   Repeat Consultation

C795   Geriatric Psychiatric Consultation

C695   Neurodevelopmental Consultation

C193   Specific Assessment

C194   Specific Re-Assessment

 

Hospital Rounding – Automatic Codes (IPTMA, IPTXA)

Service codes for rounding will differ depending on the number of days the patient has been admitted. The MDBilling.ca automatic codes allow a physician to enter one code for rounding. Our software system will automatically choose the correct (and highest paying) inpatient subsequent visit service allowed based on the admission date entered. 

 

HOW TO USE:

IPTMA (MRP Rounding): Our system will choose the correct inpatient subsequent visit code and add the MRP premium (E083/E084) for you.

 

IPTXA (Non-MRP - covering): Our system will choose the correct inpatient subsequent visit code for you.

 

MRP Subsequent Visit Premium

E083   Weekday

E084   Saturday, Sunday or Holiday

 

Day / Week after admission

IPTMA (MRP Rounding)

IPTXA (Non-MRP – covering)

1st Day

C122A + E083A/E084A

C192A

2nd Day 

C123A + E083A/E084A

1 – 5th Week

C192A + E083A/E084A

6 - 13th Week

C197A + E083A/E084A

C197A

13th + Week

C199A + E083A/E084A

C199A


Other Subsequent Visit by MRP

C142 + E083   1st day following transfer from ICU

C143 + E083   Second day following transfer from ICU

C124 + E083   Day of discharge (patient must be in hospital for at least 48 hours).

 

Other Visit 

C121   Additional visit due to intercurrent illness

C198   Concurrent Care

C982   Palliative Care

 

Psychotherapy, Family Psychotherapy, Hypnotherapy, Psychiatric Care 

*units = ½ hour

Outpatient (per unit)

In-patient (per unit)

Psychiatric Care

K198   

K199   

Family Psychiatric Care

K196  

K191   

Individual Psychotherapy 

K197   

K190   

Family Psychotherapy (2 + members)

K195  

K193   

Note: for in-patient services, the admission date and facility are required in the claim submission.

 

Group Psychotherapy 

* per member - first 12 units per day

# of people

Outpatient (per unit)

In-patient (per unit)

2 people

K208   

K210

3 people

K209   

K211

4 people

K203   

K200

5 people

K204   

K201

6 to 12 people

K205 

K202

Additional units per member 

(max 6 per patient per day)

K206

K207

 

Hypnotherapy 

K192   Individual, per unit

K194   Group for induction and training for hypnosis per member (max of 8), per unit

 

Community Psychiatric Care Modifiers / Premiums

K187   Acute Post Discharge Psychiatry Billing Premium - Adds 15% to K195, K196, K197, K198

K188   High risk community psychiatric care (available during a 6 month period following a suicide attempt) - Adds 15% to A190, A191, A192, A195, A197, A198, A695, A795, K195, K196, K197, K198

K189   Urgent Community Psychiatric Follow up Add $200 to A190, A195, A695, A795

 

Assessment under the Mental Health Act 

K620   Consultation for involuntary psychiatric treatment, per unit

K623   Form 1 Application for psychiatric assessment

K624   Form 3 Certification of involuntary admission

K629   Form 3 All other re-certifications of involuntary admission including completion of forms

 

MDBilling.ca Billing Resources

Learning Video: Learn Psychiatry Billing in Under 8 Minutes

To know more about how to bill virtual services, please refer to Virtual Care Billing Guide during COVID-19

 

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