What are the billing rules for K045A?

One per patient per 12 months (A99). Only payable if the physician gave at least 4 consultations or assessments, K013, K033, K029, K002 or K003 to the patient in the 12 months the claim covers (A99). Only payable when the physician has more than 100 patients with diabetes per year (A99).

What is K045A often billed with?

A151, A153 or A154 endocrinology visits, which count toward the 4 required services (A99). K046 diabetes team management (internist or endocrinologist with an employed Certified Diabetes Educator) is payable in addition to K045 (A100, A101).

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Billing code

K045A — Diabetes Management By A Specialist

Q: What is OHIP billing code K045A?

Annual fee for the internist, endocrinologist or paediatrician managing a diabetic patient to CDA guidelines. Once per patient per 12 months.

Specialist annual diabetes management

Bill K045 once a year when an internist, endocrinologist or paediatrician manages a diabetic patient to Diabetes Canada guidelines with a flow sheet.

Watch for: Needs at least 4 qualifying visits with the patient in the 12 months and more than 100 diabetic patients a year.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$80.25	$0.00	$0.00	$0.00

Code: K045A
Description: Diabetes Management By A Specialist
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

Annual fee for the internist, endocrinologist or paediatrician managing a diabetic patient to CDA guidelines. Once per patient per 12 months.

What it covers

K045 is payable to a specialist in Endocrinology, Internal Medicine or Paediatrics who is most responsible for the ongoing management of a diabetic patient. It covers coordinating, providing and documenting ongoing care with a planned care approach consistent with the current Canadian Diabetes Association (CDA) Clinical Practice Guidelines (A99).

The record must show the CDA required elements for the previous 12 months, at minimum: lipids, cholesterol, HbA1C, blood pressure, weight and BMI, and medication dosage; discussion and offer of vascular protection and influenza and pneumococcal vaccination; health promotion counselling and self-management support; albumin to creatinine ratio; discussion and offer of referral for a dilated eye exam; and foot and neurologic exams (A99).

Billing rules

One per patient per 12 months (A99).
Only payable if the physician gave at least 4 consultations or assessments, K013, K033, K029, K002 or K003 to the patient in the 12 months the claim covers (A99).
Only payable when the physician has more than 100 patients with diabetes per year (A99).
Payable only to Internal Medicine (13), Endocrinology (15) or Paediatrics (26) (A99).
A flow sheet or diabetic registry record covering the previous 12 months, with the required elements, must be in the chart (A99).
Submit the claim only once the required elements have been completed for the previous 12 months (A99).
Comprehensive virtual visits by video or phone count as consultations or assessments toward the visit requirement (A75).

Often billed with

A151, A153 or A154 endocrinology visits, which count toward the 4 required services (A99).
K046 diabetes team management (internist or endocrinologist with an employed Certified Diabetes Educator) is payable in addition to K045 (A100, A101).

Related codes: K046, K030, Q040, A151, A153, A154, K029

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Endocrinology & Metabolism (15), Diabetes management by a specialist, page A99 (also listed under Internal Medicine and Paediatrics); Virtual Care Services page A75

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