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Billing code

K030A — Diabetic Management Assessment (4/yr)

Diabetes management visit

Bill K030 when the most responsible physician gives an all-inclusive diabetes follow-up visit and keeps a diabetic flow sheet.

Watch for: Maximum 4 per patient per 12 months, and it pays nil with another visit by you that day or without the flow sheet.

Code

K030A

Description

Diabetic Management Assessment (4/yr)

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

Diabetic management assessment: an all-inclusive diabetes follow-up visit by the most responsible physician, with a flow sheet. Up to 4 per 12 months.

What it covers

K030 is an all-inclusive service for the most responsible physician providing continuing management and support of a diabetic patient (A53).

It must include an intermediate assessment, a level 2 paediatric assessment or a partial assessment focused on diabetic target organs, relevant counselling, and a diabetic flow sheet kept in the chart. The flow sheet tracks lipids, cholesterol, HbA1C, urinalysis, blood pressure, fundal exam, peripheral vascular exam, weight and BMI, and medication dosage (A53).

Billing rules

• Maximum 4 per patient per 12 months (A53).
• Pays nil if another consultation or visit is billed by you for the same patient the same day, or if the flow sheet isn't kept (A53).
• Payable only to the physician most responsible for the patient's diabetes care (A53).
• May be done by video or phone as comprehensive virtual care, but a virtual K030 pays only if an in-person K030 was done in the preceding 12 months (A75, Appendix J AJ1).
• Three K030s for the same patient in the same 12 months are required before Q040 (diabetes management incentive) can be billed (A53).

Often billed with

• Q040 diabetes management incentive, once per 12 months after at least 3 K030s and documentation of the CDA elements (A53).
• E080 first visit after hospital discharge, within 2 weeks of an acute in-patient discharge (GP28).
• FHO: Q012A after-hours premium for enrolled patients (FHO Agreement p.68, §8.12).

Common rejections

• 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).
• 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).
• EQE: The physician isn't registered in the group whose number was on the claim for that date; check the group number (EQE guide).
• A3H: More services were billed than OHIP allows on the line; K030 is one service per visit and 4 per 12 months (A3H guide; A53).

Related codes: Q040, K029, A007, E080

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), page A53.

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