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Billing code

Q040A — Diabetes Management Incentive (Annual) Flow Sheet. Min K030 X 3

Diabetes management incentive

Bill Q040 once per 12 months as the family physician most responsible for a diabetic patient, once all required care elements are complete.

Watch for: Payable only after at least three K030 visits for the same patient in that 12 months, with a completed flow sheet.

Code

Q040A

Description

Diabetes Management Incentive (Annual) Flow Sheet. Min K030 X 3

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

Annual diabetes management incentive for the family physician most responsible for a diabetic patient, after at least three K030 visits.

What it covers

Q040 is the diabetes management incentive in the Family Practice section of the Schedule (A53). It is billed by the general or family physician most responsible for the ongoing management of a diabetic patient, using a planned-care approach consistent with Diabetes Canada (CDA) guidelines, once all required elements have been provided for the previous 12 months (A53).

The record must track at least: lipids, cholesterol, HbA1C, blood pressure, weight and BMI, and medication dosage; discussion and offer of vascular protection, influenza and pneumococcal vaccination; health promotion counselling and self-management support; albumin-to-creatinine ratio; offer of referral for a dilated eye exam; and foot and neurologic exams (A53).

Unlike most Q-codes, Q040 is part of the Schedule itself, not Appendix Q.

Billing rules

• Maximum one per patient per 12-month period (A53).
• Payable only if the physician billed at least three K030 for the same patient in the same 12-month period (A53).
• A flow sheet or other record of all required CDA elements must be in the patient's permanent record, or it isn't payable (A53).
• Submit only once the required elements are complete for the previous 12 months (A53).
• Can be submitted alone or with other fee codes (OMA Q-codes guide p.12).
• Open to fee-for-service and patient enrolment model physicians, for enrolled and non-enrolled patients (OMA Q-codes guide p.12).
• A second Q040A within 365 days by the same physician pays zero with explanatory code M1; by a different physician it rejects A36; a physician without billing specialty 00 gets AD4 (OMA Q-codes guide p.12).

Often billed with

• K030 diabetic management assessment, at least three in the same 12-month period (A53).

Common rejections

• 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: K030, Q050, A007

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), Diabetes management incentive, page A53

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