OHIP billing code for diabetes management
Updated October 26, 2026
Family physicians bill K030A ($45.75), the diabetic management assessment, for diabetes follow-up visits, up to 4 per patient per 12 months. After at least 3 K030A visits in 12 months, bill Q040A ($65.70), the annual diabetes management incentive. Use diagnostic code 250.
| Code | What it is | Fee | When to bill it |
|---|---|---|---|
| K030A | Diabetic management assessment | $45.75 | A diabetes follow-up visit by the most responsible physician, with a diabetic flow sheet. Up to 4 per 12 months. |
| Q040A | Diabetes management incentive | $65.70 | Once per 12 months, after at least 3 K030 in that period and once all required elements are documented. |
| K029A | Insulin therapy support, per unit | $80.00 | Counselling and support for patients on 3 or more insulin injections a day or a pump. Maximum 6 units per year. |
| K140A | Chronic disease shared appointment, 2 patients, per patient per unit | $40.05 | A group visit for patients with established diabetes. K141A to K144A for 3 to 12 patients. |
How to bill it
Keep a diabetic flow sheet in the chart that tracks lipids, cholesterol, HbA1C, urinalysis, blood pressure, fundal exam, peripheral vascular exam, weight and BMI, and medication dosage. K030 pays nil without it (A53).
At each diabetes follow-up, bill K030A instead of an assessment. It must include an intermediate assessment (or a target-organ partial assessment) and counselling (A53).
After at least 3 K030 in a 12-month period, and once the Diabetes Canada (CDA) required elements for those 12 months are documented, bill Q040A once (A53).
For patients on intensive insulin, time-based support and device teaching you give personally can be billed as K029A per half-hour unit (A52).
Billing rules
- K030: maximum 4 per patient per 12 months; payable only to the physician most responsible for the patient's diabetes care (A53).
- K030 pays nil if you bill another consultation or visit for the same patient the same day (A53).
- K030 can be done by video or phone, but a virtual K030 pays only if an in-person K030 was done in the preceding 12 months (A75).
- Q040: one per patient per 12 months; needs at least 3 K030 by you in the same 12 months; the record must show the CDA elements, including albumin-to-creatinine ratio, offer of a dilated eye exam referral, foot and neurologic exams, and offer of influenza and pneumococcal vaccination (A53).
- Q040 is open to fee-for-service and enrolment-model physicians, for enrolled and non-enrolled patients (OMA Q-codes guide p.12).
- K029: maximum 6 units per patient per physician per year; nil with another consultation or visit the same day (A52).
- FHO: K030 and K029 aren't in-basket, and K030 earns the Q012A after-hours premium for enrolled patients (Agreement p.68 §8.12, Schedule 2 p.79).
- Specialists (internal medicine, endocrinology, paediatrics) use K045 for diabetes management, not Q040 (A99).
Diagnostic codes
- 250: Diabetes mellitus, including complications
Common rejections
- M1: On the remittance advice: a second Q040A within 365 days by the same physician pays $0 (OMA Q-codes guide p.12).
- A36: OHIP's description is 'claimed by other practitioner'. Another physician already billed Q040A for the patient within 365 days (OMA Q-codes guide p.12).
- AT3: Billed as comprehensive virtual care (K300A or K301A), but OHIP found no existing patient-physician relationship: no in-person insured service with you in the past 24 months and no enrolment to you or your group (A66). Otherwise bill limited virtual care, A101A or A102A.
Questions
What is the OHIP billing code for diabetes management?
Family physicians bill K030A ($45.75), the diabetic management assessment, for diabetes follow-up visits, up to 4 per patient per 12 months. After at least 3 K030A visits in 12 months, bill Q040A ($65.70), the annual diabetes management incentive. Use diagnostic code 250.
Can I bill K030 and A007 on the same day?
No. K030 pays nil if you bill another consultation or visit for the same patient the same day (A53). Bill one or the other.
When do I submit Q040?
After the 12-month period, once you have at least 3 K030 for the patient in it and all required elements are documented (A53).
Can K030 be done by phone?
Yes, as comprehensive virtual care with K301A, but only if an in-person K030 was done in the preceding 12 months (A75).
Related: OHIP billing code for smoking cessation · OHIP billing code for phone visit
Sources
- Schedule of Benefits: Physician Services (July 1, 2026)
- OMA: Primary Care Q-Codes Quick Reference Guide
- INFOBulletin 260308: 2024 PSA, FHO+ implementations for April 2026
- Ministry of Health: Diagnostic Codes (2026)
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