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Billing code

K132A — Adult (>65 yo) Periodic Health Assessment

Senior annual physical, 65+

Bill K132 for a periodic health visit for an adult aged 65 or older with no acute illness.

Watch for: One per patient per physician per 12 months, and the patient must be 65 or older on the service date.

Code

K132A

Description

Adult (>65 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 65 and older 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).

K132 is the Family Practice periodic health visit for adults, age 65 and older (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 K131 for patients aged 18 to 64 (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).
• K132 is paid with the 15% age premium for patients 65 and older (GP64).
• 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

• A2A: The patient was under 65 on the service date. Bill K131 (18 to 64) instead, and check the date of birth on the claim.
• 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.
• 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.
• VH8: The date of birth doesn't match OHIP's record for the health number. Correct it and resubmit.

Related codes: K131, K133, K130, 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)

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