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Billing code

Q020A — Bipolar for 10+ patients

Bipolar disorder tracking code

Add Q020A to claims for enrolled patients with bipolar disorder so they count toward the annual serious mental illness premium.

Watch for: The patient must be enrolled to the billing physician, or the claim is processed but not counted.

Code

Q020A

Description

Bipolar for 10+ patients

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Oct 1, 2003

Termination date

No end date

Explanation

Updated October 26, 2026

Tracking code on claims for enrolled patients with bipolar disorder, counted toward the annual serious mental illness premium.

What it covers

Q020A is the bipolar disorder tracking code for the serious mental illness (SMI) premium (AQ11). The premium is an annual special payment for comprehensive primary care of enrolled patients with bipolar disorder or schizophrenia. Q020A goes on the fee-schedule claims for services to bipolar patients; Q021A is used for schizophrenia (Agreement p.68 §8.11; OMA Q-codes guide p.9).

Appendix Q is information only, not part of the Schedule (AQ1). The rules below come from the 2020 OMA Q-codes guide and, for FHO physicians, the April 2026 FHO agreement (FHO+ terms from April 1, 2026).

Billing rules

• The patient must be enrolled to the billing physician (Agreement p.68 §8.11; OMA Q-codes guide p.9).
• FHO agreement: the first premium level is reached with at least 5 such patients managed in the fiscal year, and a second level with at least 10 (Agreement p.68 §8.11).
• Models per Appendix Q: FHN, FHO, FHG, BSM, GHC, RNPGA, WAHA, SJHC, GP Focused HIV and the Sioux Lookout Agreement (AQ11).
• OMA guide: FHG physicians track schizophrenia with diagnostic code 295 on the service instead of Q021A (OMA Q-codes guide p.9).
• Claims for patients not yet enrolled are processed but not counted. If enrolment is processed in the following 12 months, claims after enrolment count automatically (OMA Q-codes guide p.9).
• Paid during the fiscal year as a Special Premium Payment, shown as an accounting transaction on the monthly remittance advice (OMA Q-codes guide p.9). FHO special premiums go to the physician's own account (Agreement p.58 §3.2).

Often billed with

• The fee-schedule codes for each service to the enrolled bipolar patient (Agreement p.68 §8.11).

Common rejections

• EPA: Q020A is limited to physicians in the listed models; EPA means OHIP doesn't show the physician approved to bill it under the billing number and group used.
• EH2: The health card version code on the claim doesn't match OHIP's record for the patient; get the current version code and resubmit.

Related codes: Q021, Q200

Source: Schedule of Benefits (July 1, 2026), Appendix Q (information only), Premiums Payable With Comprehensive Virtual Care Services, page AQ11

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