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Billing code

K005A — Primary Mental Health Care

Primary mental health care

Bill K005 per half-hour unit for individual assessment and treatment of mental or emotional problems, in person or by video or phone.

Watch for: Record start and stop times; under 20 minutes isn't billable, and a same-day assessment needs a clearly different diagnosis.

Code

K005A

Description

Primary Mental Health Care

FHO+ basket

Covered by the FHO+ base rate payment for enrolled patients, and shadow billed at 30% (50% for Schedule 2B procedures).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Primary mental health care: individual assessment and treatment of mental or emotional problems by a family physician, billed per half-hour unit.

What it covers

Primary mental health care is any combination of assessment and treatment for mental illness, behavioural maladaptations or other problems assumed to be emotional in nature, considering the patient's biological and psychosocial functioning (GP56).

It includes the needed history and brief exam, related procedures not separately listed, arranging tests or follow-up, and advice by phone or otherwise about the service (GP54).

Billing rules

• Not payable the same day as a consultation or other assessment by you to the same patient unless the two services have clearly different diagnoses (GP55, A21).
• Units are ½ hour or major part: 1 unit = at least 20 minutes, 2 units = 46, 3 units = 76, 4 units = 106, then every 30 minutes more (GP55).
• Count consecutive time in direct contact with the physician in person, excluding other separately billed services and chart work (GP54, GP55).
• Record start and stop times in the chart, or the service is not eligible for payment (GP7).
• Under 20 minutes is not this service; bill the assessment you actually provided (GP55).
• May be given by video or phone as comprehensive virtual care; add K300A or K301A. By phone it pays 95% of the in-person fee, not the usual 85% (A70, Appendix J AJ1).

Often billed with

• E079 smoking cessation initial discussion (A56).
• E080 first visit after hospital discharge, office or home, within 2 weeks of an acute in-patient discharge (GP28).
• FHO: Q012A after-hours premium for enrolled patients (FHO Agreement p.68, §8.12). K005 is in basket (Agreement Schedule 2, p.79).

Common rejections

• AT3: Usually means it was billed as virtual care (K300A/K301A) and OHIP found no existing patient-physician relationship, such as an in-person visit with you in the past 24 months (AT3 guide; A66).
• EH2: The health card version code doesn't match OHIP's record; get the current version code and resubmit (EH2 guide).
• VJ7: The claim reached OHIP more than three months after the service date; resubmit as stale-dated only if it was first sent on time (VJ7 guide; GP9).
• VH8: The date of birth doesn't match OHIP's record for the health number; correct it and resubmit (VH8 guide).
• EQE: The physician isn't registered in the group whose number was on the claim for that date; check the group number (EQE guide).

Related codes: K007, K013, K004, K006, K198, E079, E080

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), page A21; rules GP54–GP56.

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