Psychiatry OHIP Billing Codes 'Cheat Sheet'

 

Psychiatry OHIP Billing Codes 'Cheat Sheet'

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Knowing which billing fee codes are available within your speciality is essential in order to maximize your earning potential and free up the amount of time you spend on billing.

While psychiatry billing used to be complex, difficult and time-consuming, each year it’s getting easier and easier thanks to automated services, mobile billing, and in general, just more support.

In order to help you further on your billing journey, we’ve put together this psychiatry billing cheat sheet that you can bookmark and reference at any time. If you’re interested in a downloadable/printable version just scroll to the bottom.


Psychiatry OHIP Billing Guideline 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.


Outpatient Psychiatry OHIP Billing Codes

A195 Consultation

A895 Consultation, when using a special visit to a hospital inpatient, long term care inpatient or emergency department patient.

 

Visit to Emergency Department for Consultation or Assessment

*Use the A prefix and add a premium for time and travel if you were outside the hospital when called.

Weekdays Mon. - Fri. "Sacrifice of Office hours" Evenings M-F Weekends & Holidays Nights
Travel Premium K960 : $36.40 Max. 2 K961 : $36.40 Max. 2 K962 : $36.40 Max. 2 K963 : $36.40 Max. 6 K964 : $36.40 Unlimited
First Person Seen K990 : $20.00 Max. 1 K992 : $40.00 Max. 1 K994 : $60.00 Max. 1 K998 : $75.00 Max. 1 K996 : $100.00 Unlimited
Additonal Person(s) Seen K991: $20.00 Max. 9 K993: $40.00 Max. 9 K995: $60.00 Max. 9 K999: $75.00 Max. 19 K997: $100.00 Unlimited

Example: You see a patient in emerg at 10:00. You would bill A895 with K990.


In Patient: Special Visit Premium

**When using a premium for time and travel for In Patients make sure the consult/assessment is the prefix A:

Weekdays Mon. - Fri. "Sacrifice of Office hours" Evenings Mon. - Fri. Weekends & Holidays Nights
Travel Premium C960 : $36.40 Max. 2 C961 : $36.40 Max. 2 C962 : $36.40 Max. 2 C963 : $36.40 Max. 6 C964 : $36.40 Unlimited
First Person Seen C990 : $20.00 Max. 1 C992 : $40.00 Max. 1 C994 : $60.00 Max. 1 C986 : $75.00 Max. 1 C996 : $100.00 Unlimited
Additonal Person(s) Seen C991: $20.00 Max. 9 C993: $40.00 Max. 9 C995: $60.00 Max. 9 C987: $75.00 Max. 19 U997: $100.00 Unlimited
 

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 eg: 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.

A395 Limited Consultation

A196 Repeat Consultation

A193 Specific Assessment

A194 Partial Assessment

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. 

****Billing Reminder: A197, A198 , A191 , A192  not eligible for payment with family psychiatric care or family psychotherapy. 

 

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 Patient Minimum time 1 unit K630 Minimum time 2 unit K632 A190, C190, W19090 mins.106 mins.136 mins. A19560 mins.76 mins.106 mins. A197 Sole Service60 mins.76 mins.106 mins. A198 Sole Service60 mins.76 mins.106 mins. A197/ A198 same patient, same day.120 mins.136 mins.166 mins. A695, C695, W695120 mins.136 mins.166 mins. A795, C795, W79590 mins.106 mins.136 mins. A895, C895, W89560 mins.76 mins.106 mins. A19160 mins.76 mins.106 mins. A19260 mins.76 mins.106 mins. A191/A192 same patient, same day.120 mins.136 mins.166 mins.

In Patient Psychiatry OHIP Billing Codes

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

patient and doctor taking notes
 

Subsequent Visit Psychiatry OHIP Billing Codes

C192 Daily for the first 5 weeks

C197 Week 6-13 (maximum 3 per week)

C199 After week 13 (maximum 6 per month)

C192 Daily for the first 5 weeks

C197 Week 6-13 (maximum 3 per week)

C199 After week 13 (maximum 6 per month)

 

Subsequent Visit (by MRP) Psychiatry OHIP Billing Codes

The MRP is the physician who admits the patient to the hospital. The MRP can transfer doctors and specialties throughout a patient’s hospital stay, but only one doctor can be MRP for the patient at one time. If you’re the MRP you’re eligible for the E083 premium that adds 30% to the subsequent visit code

C122  Day following the hospital admission assessment.

C123  Second day following the hospital admission assessment.

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

 

Subsequent Visit (by MRP) following a transfer from ICU

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C142 First day following transfer from ICU

C143 Second day following transfer from ICU

C121 Additional visit due to intercurrent illness

C198 Concurrent Care

C982 Palliative Care

 

Long Term Care In Patient Psychiatry OHIP Billing Codes

W895 Consultation

W190 Special Psychiatric Consultation

W795 Geriatric Psychiatric Consultation

W695 Neurodevelopmental Consultation

W395 Limited Consultation

W196 Repeat Consultation

 

Psychotherapy, Family Psychotherapy, Hypnotherapy, Psychiatric Care *units ½ hour

K198 Outpatient per unit

K199 In patient per unit

 
Empathy

Family Psychiatric Care

K196  Outpatient per unit

K191 In patient per unit

 

Psychotherapy OHIP Billing Codes

K197  Individual outpatient psychotherapy per unit.

K190  Individual in patient psychotherapy per unit.

K195  Family psychotherapy outpatient (2 or more members) per unit.

K193 Family psychotherapy in patient (2 or more members) per unit.

 

Group Psychotherapy OHIP Billing Codes

Outpatients, per member, first 12 units per day

K208  2 people per unit

K209  3 people per unit

K203  4 people per unit

K204  5 people per unit

K205  6 to 12 people per unit

K206  additional units per member (max 6 per patient per day) per unit.

Inpatients, per member, first 12 units per day

K210   2 people per unit

K211   3 people per unit

K200   4 people per unit

K201   5 people per unit

K202   6 to 12 people per unit

K207 Additional units per member (max 6 per patient per day) per unit.

 

Hypnotherapy OHIP Billing Codes

K192  Individual per unit

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

Hypnotherapy.jpg
 

Community Psychiatric Care

Acute Post Discharge Psychiatry Billing Premium

K187 Adds 15% to K195, K196, K197, K198

High risk Psychiatry Billing Premium

(available during a 6 month period following a suicide attempt).

K188 Adds 15% to A190, A191, A192, A195, A197, A198, A695, A795, K195, K196, K197, K198

 

Urgent Community Psychiatric Follow up Billing Codes

K189 – add $200 to A190, A195, A695, A795

 

Assessment under the Mental Health Act Billing Codes

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.


Psychiatry OHIP Billing Codes ‘Cheat Sheet’
Downloadable PDF file


If you’re interested in the most commonly used Psychiatry 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.”

Psychiatry OHIP billing codes Searchable Database

 

Final Takeaway:

Remember you have the option of "starring" your most commonly used billing codes. That way, they’ll appear at the top for searching.

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Contact us if you have any questions regarding Psychiatry Billing codes.


Looking to maximize your billing?

Check out The Ultimate OHIP Billing Guide for more tips, tricks and automated features!