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Billing code

K133A — Annual Exam Intellectual and Developmental Disability

Annual physical, developmental disability

Bill K133 for an adult with an intellectual or developmental disability: at least 50 minutes of contact, a care plan and a listed diagnostic code.

Watch for: Use diagnostic code 299, 319, 343, 741 or 758; only one of K131, K132 or K133 per 12 months.

Code

K133A

Description

Annual Exam Intellectual and Developmental Disability

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

Annual periodic health visit for adults with intellectual and developmental disabilities: at least 50 minutes, a care plan, and a listed diagnostic code.

What it covers

K133 is a periodic health visit for an adult with IDD: an intermediate assessment, history, physical exam, health screening, relevant counselling, and a coordinated care and management plan consistent with the Canadian consensus guidelines on primary care of adults with IDD (A8).

It must include: review of needs for accommodation and other access issues; proactive review of genetic and psychosocial risks; review of chronic diseases; review of systems; an in-person exam with vital signs including weight or waist circumference, hearing, vision and dentition screening, musculoskeletal and neurological screening, skin survey and any detailed exam needed; a documented care plan; and written communication of the plan to the patient and their guardian or caregiver (A8).

Billing rules

• One per patient per 12 months, and only one of K133, K131 or K132 per patient per physician per 12 months (A9).
• Needs at least 50 minutes total direct contact, which can be spread over several time periods; record start and stop times for each (A9).
• At least 26 minutes must be through direct physical encounter(s); other parts may be virtual (A9).
• Use the date all requirements were completed as the service date, and don't bill other services for the time periods counted toward K133 (A9).
• The claim must carry the diagnostic code for the patient's condition: 299, 319, 343, 741 or 758 (A9).
• E080 is not payable with K133, which isn't on the E080 list of eligible services (GP28).
• FHO: in basket (Agreement Schedule 2, p.79), and it earns the after-hours premium for enrolled patients when Q012A is on the claim (Agreement p.68, §8.12).

Often billed with

• FHO: Q012A after-hours premium for enrolled patients (Agreement p.68, §8.12).

Common rejections

• V16: The diagnostic code isn't one OHIP accepts for K133. Use 299, 319, 343, 741 or 758, whichever matches the patient's condition (A9), and resubmit.
• A2A: OHIP's record puts the patient outside the age range for K133, which is for adults with IDD (A8). Check the date of birth on the claim against the health card.

Related codes: K131, K132, K130, K125, A007

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), Periodic health visit for adults with Intellectual and Developmental Disabilities (IDD), pages A8–A9.

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