What are the billing rules for K123A?

Payable only to paediatricians who meet one of these: K122/K123 make up 35% or more of the dollar value of their fee-for-service claims in any 12 months; 35% or more come from K005, K007, K019, K020, K012, K024, K025, K010, K004, K006 or K008; or they have the additional residency or fellowship training set out on A172 (A172). Physicians who don't qualify bill the service under another code, such as K005, K013/K033 or K040/K041 (A172). Units are 1/2 hour or major part: 1 unit = at least 20 minutes, 2 units = 46, 3 units = 76, 4 units = 106, counting consecutive direct contact time (A172, GP54, GP55).

Why is K123A rejected?

A3F: OHIP's description is 'no fee for this code on service date': OHIP had no payable fee for the code on that date. Check the service date and the fee code on the claim.

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Billing code

K123A — Developmental And/or Behavioural Care - Family Developmental And/or Behavioural Care - Per Unit

Q: What is OHIP billing code K123A?

Paediatric family developmental and/or behavioural care, per half-hour unit. Only for paediatricians who meet the A172 eligibility criteria.

Paediatric developmental care, family

Bill K123 per half-hour unit for an eligible paediatrician's family 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	$116.15	$0.00	$0.00	$0.00

Code: K123A
Description: Developmental And/or Behavioural Care - Family 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

Paediatric family developmental and/or behavioural care, per half-hour unit. Only for paediatricians who meet the A172 eligibility criteria.

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 or other problems assumed to be developmental or emotional, considering the patient's biological and psychosocial functioning (A172).

K123 is the family version of the service; K122 is individual care (A172).

Billing rules

Payable only to paediatricians who meet one of these: K122/K123 make up 35% or more of the dollar value of their fee-for-service claims in any 12 months; 35% or more come from K005, K007, K019, K020, K012, K024, K025, K010, K004, K006 or K008; or they have the additional residency or fellowship training set out on A172 (A172).
Physicians who don't qualify bill the service under another code, such as K005, K013/K033 or K040/K041 (A172).
Units are 1/2 hour or major part: 1 unit = at least 20 minutes, 2 units = 46, 3 units = 76, 4 units = 106, counting consecutive direct contact time (A172, GP54, GP55).
Record start and stop times in the chart, or the service isn't payable (GP7).
K123 counts toward eligibility for the focused practice psychotherapy premium, but the 17% premium is not paid on K123 (GP56, GP57).
Can be billed by video or telephone as comprehensive virtual care with an existing relationship, with K300A or K301A; telephone pays 85% (A70, AJ1).

Common rejections

A3F: OHIP's description is 'no fee for this code on service date': OHIP had no payable fee for the code on that date. Check the service date and the fee code on the claim.

Related codes: K122, K005, K013, K033, K119

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), Developmental and/or behavioural care, page A172; General Preamble GP7, GP54 to GP57

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