What are the billing rules for K130A?

One periodic health visit per patient per physician per 12 months. Visits over the limit are not insured (GP21). No diagnostic code is required on the claim (GP21). The patient's age on the service date must fit the code. Use K017 for ages 2 to 15 and K131 from the 18th birthday (A4, GP2).

What is K130A often billed with?

E079 smoking cessation initial discussion, once per patient per 12 months (A56). FHO: Q012A after-hours premium for enrolled patients seen in evening and weekend hours or on holidays (Agreement p.68; OMA Q-codes p.8).

Why is K130A rejected?

A2A: The patient wasn't 16 or 17 on the service date. Bill K017 (2 to 15) or K131 (18 to 64) instead, and check the date of birth on the claim. VH8: The date of birth doesn't match OHIP's record for the health number. Correct it and resubmit. EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.

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Billing code

K130A — Adolescent (16 - 17 yo) Periodic Health Assessment

Q: What is OHIP billing code K130A?

Periodic health visit (annual check-up) for adolescents aged 16 or 17 with no acute illness. One per patient per physician per 12 months.

Teen annual check-up, ages 16–17

Bill K130 for a periodic health visit for a 16- or 17-year-old with no acute illness.

Watch for: One per patient per physician per 12 months, and the age must fit: K017 under 16, K131 from 18.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$87.10	$0.00	$0.00	$0.00	$0.00

Code: K130A
Description: Adolescent (16 - 17 yo) Periodic Health Assessment
FHO+ basket: Covered by the FHO+ base rate payment for enrolled patients, and shadow billed at 30% (50% for Schedule 2B procedures).
Effective date: Apr 1, 2026
Termination date: No end date

Explanation

Updated October 26, 2026

Periodic health visit (annual check-up) for adolescents aged 16 or 17 with no acute illness. One per patient per physician per 12 months.

What it covers

A periodic health visit is for a patient past their second birthday who has no apparent acute physical or mental illness. It includes an intermediate assessment (or a level 2 paediatric or partial assessment) focused on age- and gender-appropriate history, physical exam, health screening and counselling. School examinations count as periodic health visits (GP21).

K130 is the Family Practice periodic health visit for adolescents, age 16 or 17 (A4, GP2).

Billing rules

One periodic health visit per patient per physician per 12 months. Visits over the limit are not insured (GP21).
No diagnostic code is required on the claim (GP21).
The patient's age on the service date must fit the code. Use K017 for ages 2 to 15 and K131 from the 18th birthday (A4, GP2).
Periodic health visits are not on the Appendix J list, so they can't be billed by video or telephone (A68, AJ1, AJ2).
Paediatricians bill K269 (12 to 17) instead (A170).

Often billed with

E079 smoking cessation initial discussion, once per patient per 12 months (A56).
FHO: Q012A after-hours premium for enrolled patients seen in evening and weekend hours or on holidays (Agreement p.68; OMA Q-codes p.8).

Common rejections

A2A: The patient wasn't 16 or 17 on the service date. Bill K017 (2 to 15) or K131 (18 to 64) instead, and check the date of birth on the claim.
VH8: The date of birth doesn't match OHIP's record for the health number. Correct it and resubmit.
EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.
EQE: The physician wasn't registered in the group on the claim on the service date. A registration issue, not a coding one.

Related codes: K017, K131, K132, K269

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), pages A4 to A5; General Preamble GP21 to GP22 (periodic health visit)

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