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Billing code

K125A — Intellectual and developmental disability primary care

Developmental disability primary care

Bill K125 per half-hour unit for time-based primary care of a patient with an intellectual or developmental disability.

Watch for: The claim needs diagnostic code 299, 319, 343, 741 or 758, and another visit that day absorbs it.

Code

K125A

Description

Intellectual and developmental disability primary care

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

Time-based primary care for a patient with an intellectual or developmental disability, per half-hour unit. A listed diagnostic code is required.

What it covers

K125 is primary care of patients with intellectual and developmental disabilities. It can include any combination of the common and specific elements of any Family Practice & Practice in General consultation or visit, and always carries the same minimum time requirements as counselling (A50).

It is payable only when the disability is associated with autism spectrum disorder (299), intellectual disability or fetal alcohol syndrome (319), cerebral palsy (343), spina bifida (741) or a chromosomal anomaly such as Down's or Fragile X syndrome (758) (A50).

Billing rules

• The claim must carry the diagnostic code (299, 319, 343, 741 or 758) that matches the patient's condition (A50).
• If you bill any other consultation or visit for the same patient the same day, K125 is included in that service and is not paid separately (A50).
• Not on the counselling same-day list, so it isn't payable the same day as K013 by you (GP58).
• Units are ½ hour or major part: 1 unit = at least 20 minutes, 2 units = 46, 3 units = 76, 4 units = 106 (A50, GP55). Record start and stop times, or it is not payable (GP7).
• May be given by video or phone as comprehensive virtual care with K300A or K301A; by phone it pays 85% (AJ1, A70).
• FHO and FHN: in basket (core service) from April 1, 2026 (INFOBulletin 260316).

Often billed with

• K301A or K300A when the visit is by phone or video (A70).

Related codes: K133, K022, K005, K013, A007

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), Intellectual and Developmental Disability Primary Care, page A50; time units GP7, GP55.

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