What are the billing rules for K053A?

The form is given to the patient by social services staff. K053 is specific to this form and can't be claimed for completing any other government document (AF2). K053 is the Ontario Works form only; the ODSP forms have their own codes, K050 to K052 and K054 to K060 (AF1, AF2). K053 isn't one of the codes the after-hours premium is paid on, so Q012A on the same claim doesn't add a premium to it (OMA Q-codes guide p.8; Agreement p.68 §8.12).

What is K053A often billed with?

A007A intermediate assessment, when the patient is also assessed for a medical problem at the visit. Appendix F's same-day restriction applies only to the eye examinations K065 and K066, not to the ODSP and Ontario Works form codes (AF1, AF2). K050A or K055A when an ODSP form is also completed for the patient; each code is specific to its own form (AF1, AF2).

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Billing code

K053A — Ontario Works Program - Limitation to Participation

Q: What is OHIP billing code K053A?

Fee for completing the Ontario Works Limitation to Participation form, paid on behalf of MCCSS. Not an OHIP insured service.

Ontario Works participation form

Bill K053 for completing the Ontario Works Limitation to Participation form, paid for the social services ministry rather than OHIP.

Watch for: Only for this Ontario Works form; ODSP forms have their own codes, and Q012A adds no premium to it.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$17.45	$0.00	$0.00	$0.00	$0.00

Code: K053A
Description: Ontario Works Program - Limitation to Participation
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

Fee for completing the Ontario Works Limitation to Participation form, paid on behalf of MCCSS. Not an OHIP insured service.

What it covers

K053 is the fee for completing A Limitation to Participation Form for the MCCSS Ontario Works (OW) program (AF2). Questions about the form go to the local MCCSS office (AF2).

Appendix F is not part of the Schedule of Benefits and is reproduced for information only. Its services are not insured services under the Health Insurance Act; the Ministry of Health pays them as paying agent for the Ministry of Children, Community and Social Services (MCCSS) (AF1).

Billing rules

The form is given to the patient by social services staff. K053 is specific to this form and can't be claimed for completing any other government document (AF2).
K053 is the Ontario Works form only; the ODSP forms have their own codes, K050 to K052 and K054 to K060 (AF1, AF2).
K053 isn't one of the codes the after-hours premium is paid on, so Q012A on the same claim doesn't add a premium to it (OMA Q-codes guide p.8; Agreement p.68 §8.12).
FHO Income Stabilization physicians, whose services in the FHO otherwise pay $0 as globally funded, may bill K053A at full fee-for-service value (FHO agreement p.99, Appendix J §3.4–3.6).

Often billed with

A007A intermediate assessment, when the patient is also assessed for a medical problem at the visit. Appendix F's same-day restriction applies only to the eye examinations K065 and K066, not to the ODSP and Ontario Works form codes (AF1, AF2).
K050A or K055A when an ODSP form is also completed for the patient; each code is specific to its own form (AF1, AF2).

Related codes: K050, K051, K054, K055, K056

Source: Schedule of Benefits (July 1, 2026), Appendix F (information only; not insured services), MCCSS Ontario Works Program (OW), page AF2; Appendix F preamble, page AF1

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing