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Billing code

Q021A — Serious mental illness premium: schizophrenia tracking code

Schizophrenia tracking code

Add Q021A to claims for enrolled patients with schizophrenia so they count toward the annual serious mental illness premium.

Watch for: The patient must be enrolled to the billing physician for the premium to be paid.

Code

Q021A

Description

Serious mental illness premium: schizophrenia tracking code

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 schizophrenia, counted toward the annual serious mental illness premium.

What it covers

Q021A is the schizophrenia 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 schizophrenia or bipolar disorder. Q021A goes on the fee-schedule claims for services to patients with schizophrenia; Q020A is used for bipolar disorder (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.

Billing rules

• The patient must be enrolled to the billing physician for the premium to be paid (Agreement p.68 §8.11; OMA Q-codes guide p.9).
• Patients tracked with Q021A and Q020A count together. Under the FHO agreement the first premium level needs at least 5 such patients managed in the fiscal year, and a second level 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).
• The 2020 OMA guide lists Q021A for FHN and FHO only; FHG physicians tracked schizophrenia by putting diagnostic code 295 on the service instead (OMA Q-codes guide p.4, p.9). Appendix Q now lists FHG for Q021A (AQ11).
• 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

• K005A primary mental health care, or any other fee-schedule code for a service to the enrolled patient with schizophrenia (Agreement p.68 §8.11).
• K300A (video) or K301A (telephone) modality indicator on a comprehensive virtual care claim: Appendix Q lists Q021A among the premiums payable when providing eligible comprehensive virtual care services (AQ11).

Common rejections

• EPA: Q021A is limited to the models listed in Appendix Q (AQ11); EPA means OHIP doesn't show the physician approved to bill it under the billing number and group used on the claim.

Related codes: Q020, Q200, K005, K007, K300, K301

Source: Schedule of Benefits (July 1, 2026), Appendix Q (information only), Premiums Payable to Physicians When Providing Eligible Comprehensive Virtual Care Services, page AQ11; FHO agreement p.58 §3.2 and p.68 §8.11; OMA Q-codes guide p.4, p.9

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