Billing code
K269A — Paediatric periodic health visit – age 12 to 17
Teen check-up by paediatrician, 12–17
Bill K269 for a paediatrician's periodic health visit for a teen aged 12 to 17 with no acute illness.
Watch for: One per patient per physician per 12 months, and the age must fit: use K267 for ages 2 to 11.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $89.15 | $0.00 | $0.00 | $0.00 |
- Code
- K269A
- Description
- Paediatric periodic health visit – age 12 to 17
- 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 periodic health visit (check-up) for a teen aged 12 to 17.
What it covers
A periodic health visit (including a primary or secondary school exam) is for a patient who has no apparent acute physical or mental illness (GP21).
K269 is the Paediatrics listing for ages 12–17; ages 2–11 use K267 (A170, GP22).
Billing rules
- 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': K269 is for ages 12 to 17; use K267 for 2 to 11 (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: K267, A262, K130, A263
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), page A170; rules GP21–GP22.
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