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Billing code

K017A — Child (2 - 15 yo) Periodic Health Assessment

Child annual check-up, ages 2–15

Bill K017 for a periodic health visit for a child aged 2 to 15 with no acute illness.

Watch for: One per patient per physician per 12 months, and the age must fit: K130 for 16 to 17, well-baby codes under 2.

Code

K017A

Description

Child (2 - 15 yo) Periodic Health Assessment

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

Periodic health visit (annual check-up) for children aged 2 to 15 with no acute illness. One per patient per physician per 12 months.

What it covers

A periodic health visit is for a patient past their second birthday who has no apparent acute physical or mental illness. It includes an intermediate assessment (or a level 2 paediatric or partial assessment) focused on age- and gender-appropriate history, physical exam, health screening and counselling. School examinations count as periodic health visits (GP21).

K017 is the Family Practice periodic health visit for children, age 2 to 15 (A4, GP2).

Billing rules

• One periodic health visit per patient per physician per 12 months. Visits over the limit are not insured (GP21).
• No diagnostic code is required on the claim (GP21).
• The patient's age on the service date must fit the code. Use K130 for ages 16 to 17. Before the second birthday, well-baby care is billed as A007 (or A002 at 17 to 24 months) (A4, GP2).
• Periodic health visits are not on the Appendix J list, so they can't be billed by video or telephone (A68, AJ1, AJ2).
• Paediatricians bill their own periodic health visit codes, K267 (2 to 11) and K269 (12 to 17) (A170).

Often billed with

• E079 smoking cessation initial discussion, once per patient per 12 months (A56).
• FHO: Q012A after-hours premium for enrolled patients seen in evening and weekend hours or on holidays (Agreement p.68; OMA Q-codes p.8).

Common rejections

• A2A: The patient was outside 2 to 15 on the service date. Under 2, bill well-baby care (A007 or A002); at 16 or 17, bill K130. Also check the date of birth on the claim.
• EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.
• EQE: The physician wasn't registered in the group on the claim on the service date. A registration issue, not a coding one.
• EH4: The patient's OHIP coverage had ended before the service date. Confirm the health number, then the coverage.
• VJ7: OHIP received the claim more than three months after the service date (GP9). If it was first sent on time, use the stale-dated process.

Related codes: K130, K131, A007, A002, K267

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), pages A4 to A5; General Preamble GP21 to GP22 (periodic health visit)

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