What are the billing rules for K122A?

Only payable to paediatricians who meet one criterion: K122/K123 are 35%+ of annual FFS billings, or listed psychotherapy/mental-health codes (K005, K007, K019, K020, K012, K024, K025, K010, K004, K006, K008) are 35%+, or they have extra residency or fellowship training in paediatrics or psychiatry (A172). Paediatricians who don't qualify bill another code, e.g. K005, K013/K033 or K040/K041 (A172). Units: 1 unit = at least 20 minutes, 2 = 46, 3 = 76, 4 = 106, then every 30 minutes more (GP55).

Why is K122A rejected?

AT3: Billed as virtual care (K300A/K301A) and OHIP found no existing patient-physician relationship, such as an in-person service by you in the past 24 months (A66). A4D: OHIP describes this as 'Invalid specialty for this service code': K122 is a Paediatrics (26) code for eligible paediatricians (A172).

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Billing code

K122A — Individual developmental and/or behavioural care (per unit)

Q: What is OHIP billing code K122A?

Paediatrician's individual developmental and/or behavioural care, billed per half-hour unit, for eligible paediatricians.

Paediatric developmental care, individual

Bill K122 per half-hour unit for an eligible paediatrician's individual developmental or behavioural care.

Watch for: Only paediatricians who meet the eligibility criteria can bill it; others use K005, K013/K033 or K040/K041.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$102.35	$0.00	$0.00	$0.00

Code: K122A
Description: Individual developmental and/or behavioural care (per unit)
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

Paediatrician's individual developmental and/or behavioural care, billed per half-hour unit, for eligible paediatricians.

What it covers

Developmental and/or behavioural care is any combination of assessment and treatment by a paediatrician for mental illness, behavioural maladaptations, developmental disorders and other problems assumed to be developmental or emotional, considering the patient's biological and psychosocial functioning (A172).

K122 is individual care; family care is K123. A unit is ½ hour or major part (A172).

Billing rules

Only payable to paediatricians who meet one criterion: K122/K123 are 35%+ of annual FFS billings, or listed psychotherapy/mental-health codes (K005, K007, K019, K020, K012, K024, K025, K010, K004, K006, K008) are 35%+, or they have extra residency or fellowship training in paediatrics or psychiatry (A172).
Paediatricians who don't qualify bill another code, e.g. K005, K013/K033 or K040/K041 (A172).
Units: 1 unit = at least 20 minutes, 2 = 46, 3 = 76, 4 = 106, then every 30 minutes more (GP55).
Record start and stop times in the chart or the service is not paid (GP7).
K122 counts toward eligibility for the focused practice psychotherapy premium, but the premium isn't paid on K122 itself (GP57).
Can be done by video or phone with an existing relationship; add K300A or K301A (AJ1, A66, A70).

Common rejections

AT3: Billed as virtual care (K300A/K301A) and OHIP found no existing patient-physician relationship, such as an in-person service by you in the past 24 months (A66).
A4D: OHIP describes this as 'Invalid specialty for this service code': K122 is a Paediatrics (26) code for eligible paediatricians (A172).

Related codes: K123, K005, K013, K033, K040, A667

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), page A172; time rules GP54–GP61.

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