Billing code
K040A — Group counselling, per unit, where no group member received > 3 units K013 or K040 per 12 month period
Group counselling, first 3 units
Bill K040 per half-hour unit for pre-booked counselling of 2 or more patients, while no member has had over 3 K013/K040 units from you.
Watch for: Keep a separate attendance record with names and health numbers, and claim under the member with the most counselling units this year.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $80.00 | $0.00 | $0.00 | $0.00 | $0.00 |
- Code
- K040A
- Description
- Group counselling, per unit, where no group member received > 3 units K013 or K040 per 12 month period
- 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
Pre-booked group counselling for 2 or more patients, per half-hour unit, while no member has had more than 3 units of K013/K040 from you in 12 months.
What it covers
Group counselling is counselling given to two or more patients with a similar medical condition or situation (GP58). Counselling is a visit dedicated solely to an educational dialogue with the physician about the patient's problem or situation, prevention and treatment, and health maintenance (GP58).
K040 is the higher group rate, used while no group member has received more than 3 units of K013 and K040 combined from you in 12 months; after that the lower rate K041 applies (A21, GP58). Group counselling does not apply to lectures (GP59).
Billing rules
- Individual and group counselling are limited to 3 units per patient per physician per year at the higher fee (K013 or K040); later units are paid at the lesser fee (K033 or K041) (A21, GP58).
- Must be pre-booked, with an ongoing physician-patient relationship (GP58, GP59).
- Keep a separate record, apart from the medical records, of the names and health numbers of everyone at each session, or it is not payable (GP59).
- Submit the claim under the health number of the group member who, at that time, had the most counselling units already claimed by you that year (GP59).
- The same day, only the services on the counselling list are payable with it by you (for example G372, K002, K003, K008, K035, K038, K730); an assessment or K030 that day is not (GP58).
- Units are ½ hour or major part: 1 unit = at least 20 minutes, 2 units = 46, 3 units = 76, 4 units = 106; record start and stop times (GP7, GP55).
- May be given by video or phone as comprehensive virtual care with K300A or K301A (AJ1, A70).
- FHO: out of basket (not on Agreement Schedule 2, p.79), and not one of the codes that earn the after-hours premium (Agreement p.68, §8.12).
Often billed with
- G372 injection with visit, which is on the counselling same-day list (GP58).
- K301A or K300A when the group is held by phone or video (A70).
Common rejections
- EH2: The health card version code doesn't match OHIP's record, often because the patient has a newer card; get the current version code and resubmit (EH2 guide).
- R02: OHIP found the health number invalid. Group counselling is claimed under one member's health number (GP59), so check that number and version code against that member's card.
- CNA: 'Counselling not allowed': usually another service you billed that day, such as an assessment or K030, isn't on the counselling same-day list (GP58). Remove one service or correct the date.
- VH9: The health number on the claim isn't registered with the Ministry; check the group member's number used on the claim against their card and resubmit (VH9 guide).
Related codes: K041, K013, K033, K014, K015, K140
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), Counselling, Group counselling, page A21; rules GP54–GP59.
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