< Billing codes

Billing code

K131A — Adult (18 - 64 yo) Periodic Health Assessment

Adult annual physical, ages 18–64

Bill K131 for a periodic health visit for an adult aged 18 to 64 with no acute illness.

Watch for: One per patient per physician per 12 months, the age must fit, and it can't be billed by video or phone.

Code

K131A

Description

Adult (18 - 64 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 physical) for adults aged 18 to 64 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).

K131 is the Family Practice periodic health visit for adults, age 18 to 64 inclusive (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 K130 for ages 16 to 17 and K132 for 65 and older (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).
• Only one of K131, K132 or K133 (the PHV for adults with intellectual and developmental disabilities) is payable per patient per physician per 12 months (A9).

Often billed with

• E089 (+20%) when the patient is a cisgender female, or a transgender, nonbinary, gender fluid or agender patient; the gender identity must be in the chart (A4, A5).
• 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

• EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.
• A2A: The patient was outside 18 to 64 on the service date. Bill K130 (16 to 17) or K132 (65 and older) instead, and check the date of birth on the claim.
• EQE: The physician wasn't registered in the group on the claim on the service date. A registration issue, not a coding one.
• VH8: The date of birth doesn't match OHIP's record for the health number. Correct it and resubmit.
• VJ7: OHIP received the claim more than three months after the service date (GP9). If it was first sent on time, use the stale-dated process.

Related codes: K132, K130, K017, K133, A007, A003

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)

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