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Billing code

K197A — Individual psychotherapy – out-patient

Out-patient individual psychotherapy

Bill K197 per half-hour unit for individual psychotherapy with an out-patient; any specialty may bill it.

Watch for: Record start and stop times; under 20 minutes isn't psychotherapy, and a same-day assessment needs a clearly different diagnosis.

Code

K197A

Description

Individual psychotherapy – out-patient

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

Individual psychotherapy for an out-patient, billed per half-hour unit.

What it covers

Psychotherapy is treatment for mental illness, behavioural maladaptations or emotional problems where the physician deliberately builds a professional relationship with the patient to remove, modify or slow symptoms, reverse disturbed behaviour patterns and promote personal growth (GP56).

K197 is the individual out-patient listing; the in-patient version is K190 (A190). Psychotherapy can be claimed by any specialty (GP9).

Billing rules

• Billed in ½-hour units: 1 unit = at least 20 minutes, 2 = 46, 3 = 76, 4 = 106, then every 30 minutes more; count only direct contact time, excluding other separately billed services (GP54–GP55).
• Time must be consecutive (only in-patient individual psychotherapy and in-patient individual psychiatric care may add up non-consecutive time) (GP55).
• Record start and stop times in the chart, or the service is not payable (GP7).
• Under 20 minutes is not this service; bill the assessment you actually provided (GP55).
• Not payable the same day as a consultation or assessment by you for the same patient, unless the two have clearly different diagnoses (GP55).
• Not payable the same day as an obstetrical delivery by you for the same patient (GP56).
• Can be done by video or phone with an existing relationship; add K300A or K301A. By phone it is paid at 95% of the in-person fee (Appendix J, A70).

Often billed with

• K187 (+15%) within 4 weeks after discharge from a hospital stay for a psychiatric condition (A188).
• K188 (+15%) within 6 months after a suicide attempt (A188).

Common rejections

• AT3: Billed as virtual care (K300A/K301A) and OHIP found no existing patient-physician relationship, such as an in-person service by you in the past 24 months (A66).

Related codes: K198, K190, K195, K187, K188, K007

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Psychiatry (19), page A190; rules GP54–GP56.

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