OHIP billing codes: start with the visit, then check the rules

The visit is documented. You reviewed the A1C, examined the patient, discussed medications and updated the diabetes flow sheet. Now you’re deciding which OHIP fee code fits what you actually did.

That question is easier to answer with the visit in front of you than with a list of codes alone.

Berry’s billing lookup starts with a clinical scenario. You describe the service, choose Ontario when prompted and get candidate codes with the reasoning and conditions beside them. You then check the applicable Schedule before completing the claim in your billing system.

This guide uses a fictional diabetes follow-up to show that workflow on iPhone and iPad. The videos are recreated, illustrative lookups with condensed timing. The example amounts were independently checked on October 5, 2026, against Ontario’s July 2026 Schedule of Benefits and October 2026 Fee Schedule Master; they are listed fees, not a promise of payment.

What an OHIP billing code tells you

The OHIP Schedule of Benefits for Physician Services describes insured services, their fee codes and the conditions attached to payment. A code such as A007 identifies an intermediate assessment. K030 describes a diabetic management assessment with its own required elements.

A useful lookup needs to answer three questions:

1. Does the service description fit? What was provided, by whom, in which setting?
2. Were its required elements met and documented? This can include examinations, counselling, time records or a specific flow sheet.
3. Is it payable in this situation? Check frequency limits, same-day combinations, exclusions and the rules for your payment model.

The amount is one part of the answer. Choosing the largest number without checking the other parts can give you the wrong code.

Where to find Ontario’s current fee schedule

Start with the Ministry’s OHIP Schedule of Benefits and fees page. Keep that page as your reference rather than a downloaded copy whose date you might forget.

It brings together several different resources:

Resource	What it is for
Physician Services Schedule of Benefits	Service definitions, listed fees, general and specialty preambles, and payment rules.
Amendments and INFOBulletins	Changes that may affect the service you are billing or the period in which it was provided.
Fee Schedule Master	Machine-readable fee data intended for billing software. It does not replace the Schedule’s clinical and payment requirements.
Diagnostic-code list	The separate codes used to identify diagnoses or reasons associated with claims.

At the time of this review, the physician-services PDF used here was the July 22, 2026 edition, effective July 1, 2026. The Fee Schedule Master was effective October 1, 2026. For a backdated service, check the rules and amounts that applied on that service date.

Give Berry the visit, not just a diagnosis

“Diabetes billing” leaves a lot unanswered. A more useful description includes your specialty, setting, what you did and any relevant timing or previous services.

For example:

“Family practice office visit, established adult patient with type 2 diabetes. Twenty minutes: reviewed A1C, blood pressure and medications, completed a foot exam, adjusted treatment and updated the diabetes flow sheet. Third diabetes visit in twelve months.”

The duration alone does not establish eligibility for a time-based code. The documented service and the relevant requirements still matter.

On the phone, you can ask directly for OHIP codes using the clinical description. The example below shows three codes worth understanding, with their conditions rather than just their fees.

A diabetes follow-up: K030, A007 and Q040

For this example, the useful distinction is between the assessment provided today and an incentive that depends on care over time.

Code	Listed fee	Why it comes up in this example
K030 — Diabetic management assessment	$45.75	A diabetes-focused assessment with the required assessment, counselling and flow-sheet elements. Maximum four per patient, per physician, in a twelve-month period.
A007 — Intermediate assessment	$44.55	An alternative to consider when the service meets the intermediate-assessment requirements rather than the full K030 requirements. It is not an extra assessment fee to stack with K030.
Q040 — Diabetes management incentive	$65.70	An incentive with its own care and documentation requirements, including at least three K030 services in the preceding twelve months. Limited to once per patient per twelve months.

For K030, the Schedule describes an assessment including the relevant history, examination and counselling, with the required diabetic flow sheet maintained in the record. “We discussed diabetes” is not, by itself, the complete billing requirement.

The same-day rule is also important: K030 is not eligible for payment with other consultations and visits rendered by the same physician to the same patient that day. The example is not a recommendation to bill both K030 and A007.

For Q040, a third appointment is a reason to check eligibility, not an automatic entitlement. Review all the specified diabetes-care elements and the supporting documentation. Your payment model may also affect how a listed service is claimed and paid.

Those are exactly the distinctions a good lookup should bring back to your attention.

The same lookup on iPad

In the web app, ask Berry to find billing codes. If a provincial preference has not already been supplied or saved, choose Ontario. Enter the clinical scenario and select Look up codes.

The clinical scenario is supplied explicitly in this example. You do not have to rely on the tool inferring every billing-relevant detail from the open note. Include what it needs to distinguish the services, and leave patient identifiers out of the lookup description.

OHIP diagnostic codes are a separate lookup

A fee code describes the service. A diagnostic code describes the condition or reason associated with the claim. You may need both, but they come from different lists.

For diagnostic coding, use Ontario’s official diagnostic-code list. Scribeberry also offers general ICD lookup, but an ICD-10 or ICD-11 result should not be presented as an OHIP diagnostic code. The Berry demonstrations in this article are provincial fee-code lookups.

Similarly, your OHIP billing number identifies you as a provider. It is not the code for a particular assessment or procedure.

Finish the claim in your usual billing system

Use the lookup to identify the relevant service and the rules worth checking. Then confirm the code against the official sources for the service date, ensure the record supports it, and apply your clinic’s payment-model rules.

Berry does not submit the claim or guarantee that OHIP will pay it. That final billing step remains in the system you normally use.

If you work with Accuro, see how Berry connects appointments, chart preparation and note review. For a standalone starting point, there is also Scribeberry’s billing-code lookup.

The aim is straightforward: less time searching for the right section, with the requirements still in view. Meet Berry, or open Scribeberry and try a description of the service you have just provided.