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Billing code

K013A — Counselling - up to 3 units/yr

Individual counselling, first 3 units

Bill K013 per half-hour unit for a pre-booked counselling visit, for the first 3 units per patient per physician in 12 months.

Watch for: After 3 units of K013 and K040 combined in 12 months, bill K033; a same-day assessment isn't payable.

Code

K013A

Description

Counselling - up to 3 units/yr

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

Individual counselling by the physician, billed per half-hour unit. The first 3 units per patient per physician in 12 months bill as K013.

What it covers

Counselling is a visit dedicated solely to an educational dialogue with the physician about the patient's problem or situation, its prevention and treatment, and health maintenance (GP58).

Advice that would normally be part of an assessment is included in that assessment and is not counselling (GP58). Any specialty may bill counselling codes (GP9).

Billing rules

• K013 covers the first 3 units of K013 and K040 (group) combined per patient per physician per 12 months; later units are K033 (A21, GP58).
• The visit must be pre-booked, or OHIP pays it as a lesser assessment (GP58).
• The same day, you can only be paid for services on the GP58 list (for example E080, G365, G372, immunizations, K002, K003, K008, K015, K730). An assessment that day is not payable (GP58).
• 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).
• Can be done by video or phone with an existing relationship; add K300A or K301A (Appendix J AJ1, A70).

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). K013 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).
• 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).
• EH2: The health card version code doesn't match OHIP's record; get the current version code and resubmit (EH2 guide).
• CNA: 'Counselling not allowed': check for another service you billed that day that isn't on the GP58 same-day list (GP58).

Related codes: K033, K040, K041, K014, K015, K005, K007, E079, E080

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), page A21; rules GP54–GP59.

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