Billing code
K198A — Psychiatric Care - Out-patient - Per Unit
Out-patient psychiatric care
Bill K198 per half-hour unit for a psychiatrist's individual care of an out-patient, in person or by video or phone.
Watch for: Record consecutive start and stop times; a same-day assessment by you needs a clearly different diagnosis.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $102.35 | $0.00 | $0.00 | $0.00 |
- Code
- K198A
- Description
- Psychiatric Care - Out-patient - Per Unit
- 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
Psychiatric care for an out-patient, billed by a psychiatrist per half-hour unit.
What it covers
Psychiatric care is any combination of assessment and treatment for mental illness, behavioural maladaptations or other problems assumed to be emotional in nature, considering the patient's biological and psychosocial functioning (GP56).
K198 is the out-patient version, listed in the Psychiatry (19) section. K199 is in-patient psychiatric care and K196 is out-patient family psychiatric care (A190).
Billing rules
- Not payable the same day as a consultation or other assessment by you to the same patient unless the diagnoses are clearly different (GP55).
- Units are ½ hour or major part: 1 unit = at least 20 minutes, 2 units = 46, 3 units = 76, 4 units = 106, then every 30 minutes more (GP55).
- Out-patient time must be consecutive; only in-patient psychotherapy and in-patient psychiatric care may add up non-consecutive time (GP55).
- Record start and stop times in the chart, or the service is not eligible for payment (GP7).
- Under 20 minutes is not this service; bill the assessment you actually provided (GP55).
- May be given by video or phone as comprehensive virtual care; add K300A or K301A. By phone it pays 95% of the in-person fee (A70, Appendix J AJ1).
Often billed with
- K187 +15% acute post-discharge community psychiatric care, in the 4 weeks after a psychiatric in-patient discharge (A188).
- K188 +15% high-risk community psychiatric care, in the 6 months after a suicide attempt. K187 and K188 can both apply when both sets of conditions are met (A188).
- K300A or K301A modality indicator for virtual visits (A70).
Common rejections
- EH2: The health card version code doesn't match OHIP's record; get the current version code and resubmit (EH2 guide).
- AT3: Usually means it was billed as comprehensive virtual care and OHIP found no existing patient-physician relationship (AT3 guide; A66).
- VJ7: The claim reached OHIP more than three months after the service date; resubmit as stale-dated only if it was first sent on time (VJ7 guide; GP9).
- VH4: The version code on the claim is invalid; check it against the patient's current card.
- V16: The diagnostic code isn't in the plain numeric form OHIP accepts; use a three-digit code from the Ministry's list (V16 guide).
Related codes: K197, K196, K199, K187, K188, K007
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Psychiatry (19), page A190; premiums page A188; rules GP54–GP56.
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