What are the billing rules for K037A?

No other consultation, assessment, visit or time-based service by you for the same patient is payable the same day (A51). K037 is a time-based service billed in units (A51). 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). Record start and stop times in the chart, or the service is not eligible for payment (GP7).

What is K037A often billed with?

E080 first visit after hospital discharge (GP28). K300A or K301A modality indicator for virtual visits (A70).

Why is K037A rejected?

EH2: The health card version code doesn't match OHIP's record; get the current version code and resubmit (EH2 guide). EH4: The patient's OHIP coverage had ended before the service date; check the health number and the patient's eligibility (EH4 guide). V22: The diagnostic code isn't a valid OHIP code, often a four-digit code where the three-digit one is needed (V22 guide).

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Billing code

K037A — Chronic Fatigue/Fibromyalgia care

Q: What is OHIP billing code K037A?

Fibromyalgia or myalgic encephalomyelitis (chronic fatigue) care by a family physician, billed per half-hour unit, with no other visit that day.

Fibromyalgia or chronic fatigue care

Bill K037 per half-hour unit for care of a patient with fibromyalgia or myalgic encephalomyelitis.

Watch for: No other visit or time-based service by you for the patient is payable the same day; record start and stop times.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$80.00	$0.00	$0.00	$0.00	$0.00

Code: K037A
Description: Chronic Fatigue/Fibromyalgia care
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

Fibromyalgia or myalgic encephalomyelitis (chronic fatigue) care by a family physician, billed per half-hour unit, with no other visit that day.

What it covers

K037 is care for patients with fibromyalgia or myalgic encephalomyelitis. It includes the common and specific elements of all Family Practice consultation and visit services (A51).

Billing rules

No other consultation, assessment, visit or time-based service by you for the same patient is payable the same day (A51).
K037 is a time-based service billed in units (A51). 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).
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 (Appendix J AJ1, A70).

Often billed with

E080 first visit after hospital discharge (GP28).
K300A or K301A modality indicator for virtual visits (A70).

Common rejections

EH2: The health card version code doesn't match OHIP's record; get the current version code and resubmit (EH2 guide).
EH4: The patient's OHIP coverage had ended before the service date; check the health number and the patient's eligibility (EH4 guide).
V22: The diagnostic code isn't a valid OHIP code, often a four-digit code where the three-digit one is needed (V22 guide).

Related codes: K013, K005, K140, K141, K142, K143, K144

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), page A51.

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