What are the billing rules for A197A?

Patient must be less than 22 years of age. For caregivers of a patient 65 or older, or of a patient under 65 with dementia, the code is A191 (A184). Needs a written, signed request naming the consultant or specialty, the referrer and billing number, and the patient and health number, kept in the chart; otherwise it is paid as a lesser assessment, and a request obtained after the service doesn't count (GP16). Consultation limits apply: one per patient per physician per two consecutive 12-month periods for the same diagnosis, one per 12 months for a clearly unrelated diagnosis; extras are paid as an assessment (GP17, GP18).

What is A197A often billed with?

A198, the interview with the patient, for the same patient on the same day; the K630 table sets a combined 120-minute threshold for A197 + A198 (A185). K630 psychiatric consultation extension once the minimum time has passed (A185). K188 high-risk community psychiatric care premium, within six months after a suicide attempt (A188).

Why is A197A rejected?

AC4: A197 is a consultation (A184), so it needs a valid referring provider number. The number was missing, mistyped, your own, or from a provider type that can't refer; enter the referrer's six-digit number from the written request (GP16). A2A: A197 is only for a patient under 22 (A184); OHIP's record showed the patient on the claim was 22 or older on the service date. Check the date of birth, or use A191 for caregivers of a patient 65+ or with dementia.

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Billing code

A197A — Consultative Interview On Behalf Of Disturbed Patient (including Report) - Consultative Interview With Parent(s) Or Patient Representative(s) Of Patient Less Than Age 22

Q: What is OHIP billing code A197A?

Psychiatrist's interview, with report, with the parents or representatives of a disturbed patient under 22. A consultation, so it needs a written referral.

Interview with young patient's parents

A psychiatrist bills A197 for a consultative interview, with report, with the parents or representatives of a disturbed patient under 22.

Watch for: Only for patients under 22, and it is a consultation, so enter the referrer's six-digit billing number from the written request.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$271.35	$0.00	$0.00	$0.00

Code: A197A
Description: Consultative Interview On Behalf Of Disturbed Patient (including Report) - Consultative Interview With Parent(s) Or Patient Representative(s) Of Patient Less Than Age 22
FHO+ basket: Not in the FHO+ base rate basket (Schedule 2 or 2B).
Effective date: Apr 1, 2026
Termination date: No end date

Explanation

Updated October 26, 2026

Psychiatrist's interview, with report, with the parents or representatives of a disturbed patient under 22. A consultation, so it needs a written referral.

What it covers

A197 is a Psychiatry (19) consultative interview on behalf of a disturbed patient younger than 22, held with the patient's parent(s) or representative(s), and it includes a report (A184). A disturbed patient is someone with a clinically significant disturbance in cognition, emotional regulation or behaviour that limits their ability to give a reliable and complete history (A184).

The Schedule states that A191, A192, A197 and A198 are consultations (A184). A consultation follows a written request from a referring physician, nurse practitioner or dental surgeon, and includes the written report back to the referrer (GP16).

Billing rules

Patient must be less than 22 years of age. For caregivers of a patient 65 or older, or of a patient under 65 with dementia, the code is A191 (A184).
Needs a written, signed request naming the consultant or specialty, the referrer and billing number, and the patient and health number, kept in the chart; otherwise it is paid as a lesser assessment, and a request obtained after the service doesn't count (GP16).
Consultation limits apply: one per patient per physician per two consecutive 12-month periods for the same diagnosis, one per 12 months for a clearly unrelated diagnosis; extras are paid as an assessment (GP17, GP18).
Not payable for the same patient on the same day as family psychiatric care or family psychotherapy (K191, K193, K195, K196) (A184).
Detention (K001) is not payable the same patient, same day; longer interviews use the K630 extension instead. As a sole service, K630 starts after 60 minutes of direct contact; when A197 and A198 are both billed for the same patient that day, after 120 minutes (A185, GP31).
K188 (+15%) applies within six months after a suicide attempt (A188). K189 urgent community psychiatric follow-up is listed for A198 but not for A197 (A188).
A197 is a consultation (A184 note 1), so the GP64 age premium for specialist consultations applies when the patient is under 16: 10% (age 5 to 15) up to 30% (under 30 days) (A184, GP64).
Video only (with K300A), never telephone (AJ2).

Often billed with

A198, the interview with the patient, for the same patient on the same day; the K630 table sets a combined 120-minute threshold for A197 + A198 (A185).
K630 psychiatric consultation extension once the minimum time has passed (A185).
K188 high-risk community psychiatric care premium, within six months after a suicide attempt (A188).

Common rejections

AC4: A197 is a consultation (A184), so it needs a valid referring provider number. The number was missing, mistyped, your own, or from a provider type that can't refer; enter the referrer's six-digit number from the written request (GP16).
A2A: A197 is only for a patient under 22 (A184); OHIP's record showed the patient on the claim was 22 or older on the service date. Check the date of birth, or use A191 for caregivers of a patient 65+ or with dementia.

Related codes: A198, A191, A192, A195, K630, K188, K196, K195

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Psychiatry (19), Consultative interview on behalf of disturbed patient, page A184; K630 table on A185; premiums on A188; General Preamble GP16 to GP18 (consultations), GP31 (detention), GP64 (age premiums)

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