OHIP billing code for periodic health visit (annual physical)

The periodic health visit OHIP billing code depends on age: K130A for 16 and 17, K131A for 18 to 64, K132A for 65 and older.

Code	What it is	Fee
K130A	Adolescent (16 - 17 yo) Periodic Health Assessment	$87.10
K131A	Adult (18 - 64 yo) Periodic Health Assessment	$64.25
K132A	Adult (>65 yo) Periodic Health Assessment	$91.35

K130A: Adolescent (16 - 17 yo) Periodic Health Assessment

Periodic health visit (annual check-up) for adolescents aged 16 or 17 with no acute illness. One per patient per physician per 12 months.

One periodic health visit per patient per physician per 12 months. Visits over the limit are not insured (GP21).
No diagnostic code is required on the claim (GP21).
The patient's age on the service date must fit the code. Use K017 for ages 2 to 15 and K131 from the 18th birthday (A4, GP2).
Periodic health visits are not on the Appendix J list, so they can't be billed by video or telephone (A68, AJ1, AJ2).
Paediatricians bill K269 (12 to 17) instead (A170).

A2A: The patient wasn't 16 or 17 on the service date. Bill K017 (2 to 15) or K131 (18 to 64) instead, and check the date of birth on the claim.
VH8: The date of birth doesn't match OHIP's record for the health number. Correct it and resubmit.
EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.
EQE: The physician wasn't registered in the group on the claim on the service date. A registration issue, not a coding one.

Periodic health visit (annual physical) for adults aged 18 to 64 with no acute illness. One per patient per physician per 12 months.

One periodic health visit per patient per physician per 12 months. Visits over the limit are not insured (GP21).
No diagnostic code is required on the claim (GP21).
The patient's age on the service date must fit the code. Use K130 for ages 16 to 17 and K132 for 65 and older (A4, GP2).
Periodic health visits are not on the Appendix J list, so they can't be billed by video or telephone (A68, AJ1, AJ2).
Only one of K131, K132 or K133 (the PHV for adults with intellectual and developmental disabilities) is payable per patient per physician per 12 months (A9).

EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.
A2A: The patient was outside 18 to 64 on the service date. Bill K130 (16 to 17) or K132 (65 and older) instead, and check the date of birth on the claim.
EQE: The physician wasn't registered in the group on the claim on the service date. A registration issue, not a coding one.
VH8: The date of birth doesn't match OHIP's record for the health number. Correct it and resubmit.
VJ7: OHIP received the claim more than three months after the service date (GP9). If it was first sent on time, use the stale-dated process.

Periodic health visit (annual physical) for adults 65 and older with no acute illness. One per patient per physician per 12 months.

One periodic health visit per patient per physician per 12 months. Visits over the limit are not insured (GP21).
No diagnostic code is required on the claim (GP21).
The patient's age on the service date must fit the code. Use K131 for patients aged 18 to 64 (A4, GP2).
Periodic health visits are not on the Appendix J list, so they can't be billed by video or telephone (A68, AJ1, AJ2).
K132 is paid with the 15% age premium for patients 65 and older (GP64).

A2A: The patient was under 65 on the service date. Bill K131 (18 to 64) instead, and check the date of birth on the claim.
EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.
EQE: The physician wasn't registered in the group on the claim on the service date. A registration issue, not a coding one.
VJ7: OHIP received the claim more than three months after the service date (GP9). If it was first sent on time, use the stale-dated process.
VH8: The date of birth doesn't match OHIP's record for the health number. Correct it and resubmit.

The periodic health visit OHIP billing code depends on age: K130A for 16 and 17, K131A for 18 to 64, K132A for 65 and older.

Updated October 26, 2026.