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Billing code

E089A — Periodic health visit premium

Periodic health visit premium

Adds 20% to an adult periodic health visit (K131 or K132) for a cisgender female, transgender, nonbinary, gender-fluid or agender patient.

Watch for: Payable only with K131 or K132, and the patient's gender identity must be documented in the chart.

Code

E089A

Description

Periodic health visit premium

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

20% premium on an adult periodic health visit (K131 or K132) for a cisgender female, transgender, nonbinary, gender-fluid or agender patient.

What it covers

E089 adds 20% to K131 (adult 18–64) or K132 (adult 65+) periodic health visits when the patient is a cisgender female or a transgender, nonbinary, gender-fluid or agender patient (A4).

A periodic health visit is for a patient past their second birthday who has no apparent acute physical or mental illness. It must include an intermediate assessment or a partial assessment focused on age- and gender-appropriate history, physical exam, health screening and relevant counselling (GP21).

E089 is an add-on: bill it on the same claim as the K131 or K132 it applies to (A4).

Billing rules

• Payable only with K131 or K132 (A4).
• The patient's gender identity must be documented in the medical record (A5).
• The base periodic health visit is limited to 1 per patient per physician per 12 months; visits over the limit are not insured, so E089 can't apply to them (GP21).
• The premium is a percentage of the base visit fee, not a fixed amount (A4).
• No diagnostic code is required on the periodic health visit claim unless the Schedule lists one (GP21).
• K131 and K132 aren't on the Appendix J virtual care list, so the visit and E089 are in-person only (Appendix J AJ1).

Often billed with

• K131 periodic health visit, adult 18 to 64 (A4).
• K132 periodic health visit, adult 65 and older (A4).
• E430 when a cervical screening specimen is collected outside hospital at the visit (A4, J46).

Related codes: K131, K132, K130, K017, K133, E430

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), Periodic health visit, pages A4–A5; rules GP21.

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