What are the billing rules for K267A?

For a patient who has had their second birthday and shows no apparent acute physical or mental illness (GP21). Must include a level 2 paediatric assessment, intermediate assessment or partial assessment focused on age- and gender-appropriate history, exam, health screening and counselling (GP21). Limit: one per patient per physician per 12 months. Visits over the limit are not insured (GP21).

Why is K267A rejected?

A2A: OHIP describes this as 'Outside of age limit': K267 is for ages 2 to 11; use K269 for 12 to 17 (A170, GP22). AM1: OHIP describes this as 'Service limit exceeded': a second periodic health visit by the same physician within 12 months; extra visits are uninsured (GP21).

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Billing code

K267A — Paediatric periodic health visit – age 2 to 11

Q: What is OHIP billing code K267A?

Paediatrician's well-child check-up (periodic health visit) for a child aged 2 to 11.

Child check-up by paediatrician, 2–11

Bill K267 for a paediatrician's periodic health visit for a child aged 2 to 11 with no acute illness.

Watch for: One per patient per physician per 12 months, and the age must fit: use K269 for ages 12 to 17.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$48.05	$0.00	$0.00	$0.00

Code: K267A
Description: Paediatric periodic health visit – age 2 to 11
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

Paediatrician's well-child check-up (periodic health visit) for a child aged 2 to 11.

What it covers

A periodic health visit (including a primary or secondary school exam) is for a patient after their second birthday who has no apparent acute physical or mental illness (GP21).

K267 is the Paediatrics listing for ages 2–11; ages 12–17 use K269 (A170, GP22).

Billing rules

For a patient who has had their second birthday and shows no apparent acute physical or mental illness (GP21).
Must include a level 2 paediatric assessment, intermediate assessment or partial assessment focused on age- and gender-appropriate history, exam, health screening and counselling (GP21).
Limit: one per patient per physician per 12 months. Visits over the limit are not insured (GP21).
No diagnostic code is required unless specifically listed (GP21).
Diagnostic interviews and counselling with the child and/or parent are billed from the Family Practice listings (A170).
Not on the Appendix J list, so not payable as virtual care (AJ1, AJ2).

Common rejections

A2A: OHIP describes this as 'Outside of age limit': K267 is for ages 2 to 11; use K269 for 12 to 17 (A170, GP22).
AM1: OHIP describes this as 'Service limit exceeded': a second periodic health visit by the same physician within 12 months; extra visits are uninsured (GP21).

Related codes: K269, A262, A261, K017, A268

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), page A170; rules GP21–GP22.

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