ONTARIO · GUIDE
Every OHIP code an Ontario family physician bills in a typical clinic week, with fees, when to use each one, and what gets audited.
By Robin, Expert Biller, ResolvMD · 4-minute read
Published
Most of a family physician’s billing runs on a short list of codes. What goes missing usually sits around them: the after-hours premium on a rostered patient, the incentive that needed one more visit, the FHO+ time that never got logged.
This cheat sheet puts the codes an Ontario family doctor bills in a typical clinic week in one place, with the fee and when each one applies. Use it as a quick reference alongside the OHIP Schedule of Benefits, which has the full rules for every code.
General clinic assessments & consultations
| Code | Fee | What it is / when to use |
|---|---|---|
| A007 | $36.85 | Intermediate assessment: the most common general appointment code |
| A001 | $23.75 | Minor assessment: focused, brief, or single-symptom visits |
| A003 | $84.45 | General assessment: full physical exam; maximum one per patient per year |
| A004 | $45.90 | General re-assessment: full physical for a different issue or a later date |
| A005 | $84.45 | Consultation: written referral required; includes a full report back |
After-hours premium: rostered patients
Q012 adds a 50% premium for medically necessary services to rostered patients before 08:00 or after 17:00.
| Code | Fee | Eligible codes |
|---|---|---|
| Q012 | +50% | A001A, A003A, A004A, A007A, A008A, A888A, K005A, K013A, K017A, K030A, K033A, K130A, K131A, K132A, Q050 |
Special / periodic health examinations
| Code | Fee | What it is / when to use |
|---|---|---|
| K017 | $37.85 | Child periodic health visit: well-baby, milestone tracking |
| K130 | $55.15 | Adolescent periodic health visit (ages 12–17) |
| K131 | $52.20 | Adult periodic health visit (ages 18–64) |
| K132 | $75.30 | Elderly periodic health visit (ages 65+) |
| A002 | $45.15 | Enhanced 18-month well-baby visit: structured developmental screening |
FHO+ time-based add-on codes
Stack on top of roster capitation and shadow billing. Track in 15-minute increments, to a 14-hour daily maximum.
| Code | Fee | What it is / when to use |
|---|---|---|
| Q310 | $20.00 / 15 min | Direct face-to-face or synchronous video clinical care |
| Q311 | $17.00 / 15 min | Direct patient care via telephone |
| Q312 | $15.00 / 15 min | Indirect clinical work: chart documentation, lab review |
| Q313 | $15.00 / 15 min | Clinical admin: roster and chronic-disease management |
Complex consultations & special assessments
| Code | Fee | What it is / when to use |
|---|---|---|
| A911 | $150.70 | Special family practice consultation: minimum 50 minutes direct contact |
| A912 | $226.05 | Comprehensive family practice consultation: minimum 75 minutes direct contact |
| A905 | $65.90 | Limited consultation: focused second opinion, formally requested |
Chronic disease & incentive management
| Code | Fee | What it is / when to use |
|---|---|---|
| K030 | $40.55 | Comprehensive annual diabetes assessment visit |
| Q040 | $60.00 | Diabetes management incentive: paid after the third targeted visit |
| Q050 | $125.00 | Heart failure annual management incentive |
| Q150 | $7.00 | Colorectal screening incentive: ordering or counselling for a FIT kit |
| Q152 | — | Post-screening discussion: reviewing colorectal findings |
Mental health & counselling
Time tracking is legally required. Record actual minutes.
| Code | Fee | What it is / when to use |
|---|---|---|
| K005 | $67.75 / unit | Primary mental health care. 1 unit = 20–30 min; 2 units = 46+ min |
| K013 | $67.75 / unit | Individual counselling: maximum 3 units per patient per year |
| K033 | $47.70 / unit | Counselling modifier for sessions past the 3-unit limit |
Patient attachment & roster modifiers
| Code | Fee | What it is / when to use |
|---|---|---|
| Q200A | $0.00 | Zero-dollar tracker that registers a standard patient roster entry |
| Q053 | $500.00 | Complex, highly vulnerable new-patient enrollment premium |
| Q23A | $150.00 | Unattached-patient attachment fee: patient taken directly from an inpatient unit |
| Q054 | $350.00 | Combined registration premium: co-attaching a mother and newborn |
Special visit premiums: travel & urgency
| Code | Fee | What it is / when to use |
|---|---|---|
| U002 | $36.40 | Travel premium: urgent office visits, weekday daytime |
| W960 | $36.40 | Long-term care travel premium: weekday night/evening callouts |
| W996 | $100.00 | First-patient premium: late-night urgent LTC admission callout |
Before you submit
Missed revenue in family practice is rarely a wrong code. More often, it’s a premium, incentive or time code that was never added. A quick pass against this sheet at the end of each clinic day helps catch those before they’re gone.
Official sources
Every family medicine code, billed right
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