Periodic health visit for adults with Intellectual and Development Disabilities (K133)
Education and Prevention Committee Billing Briefs
Education and Prevention Committee (EPC) Billing Briefs are prepared jointly by the Ministry of Health (MOH) and the Ontario Medical Association (OMA) to provide general advice and guidance to physicians on billing matters.
Category: Family Medicine (00); all other physicians who provide comprehensive primary care to adults with intellectual and developmental disabilities
Date of publication: May 27, 2025
Background
The 2018 Canadian consensus guidelines for primary care of adults with intellectual and developmental disabilities (IDD) notes, “While annual physical examinations are not considered beneficial for asymptomatic adults with no risk factors in the general population, comprehensive health assessments, including a physical examination and preventive care actions, are recommended for adults with intellectual and developmental disabilities (IDD) in the 2018 Canadian consensus guidelines for primary care of adults with IDD.” (Health checks for adults with intellectual and developmental disabilities in a family practice | The College of Family Physicians of Canada (cfp.ca))
K133 – Periodic health visit for adults with Intellectual and Development Disabilities (IDD)
A periodic health visit for adults with IDD is a service performed on an adult (a person 18 years of age and older) with IDD that consists of an intermediate assessment and associated planning/management for the purposes of screening and health maintenance, consistent with the current Canadian consensus guidelines on the primary care of adults with IDD (Primary care of adults with intellectual and developmental disabilities: 2018 Canadian consensus guidelines - PubMed) and must include all of the following:
- Evaluation for and identification of any need for special accommodations in clinical settings as well as other health care access issues,
- Proactive review of the patient’s genetic and psychosocial risks,
- Review of any chronic diseases,
- Review of systems,
- An in-person physical examination that includes, at a minimum:
- Measurement of vital signs including weight or waist circumference,
- Screening for abnormalities in hearing, vision, and dentition,
- Screening examination of musculoskeletal and neurological systems,
- Survey examination of skin,
- Detailed examination of any part(s), region(s) or system(s) needed to make a diagnosis, and/or rule out disease as a contributing factor,
- Documentation of a coordinated care and management plan,
- Written communication of the care and management plan to the patient and their guardian, legal representative or other caregiver.
Patient populations where K133 is applicable
K133 is only eligible for payment when the patient has an IDD, starting in childhood (before 18 years) related to one of the following conditions (listed with MOH diagnostic codes):
- Autism spectrum disorder (299)
- Intellectual disability or fetal Alcohol Syndrome (319)
- Cerebral Palsy (343)
- Spina bifida, with or without hydrocephalus, meningocele, meningomyelocele (741)
- Chromosomal anomalies such as Down’s syndrome, Fragile X syndrome or other autosomal anomalies (758)
Note that periodic health visits for children, adolescents or adults without IDD may be claimed using fee codes listed on GP22 of the Schedule.
Time requirements
The elements required to complete a K133 service can be provided over multiple distinct time periods, however:
- A minimum of 50 minutes total time spent in direct contact with the patient is required.
- Start and stop times must be recorded for each time period related to the service.
- No other services are eligible for payment for the time periods used to meet the time requirements of this service.
- While some aspects of the K133 may be provided virtually, a minimum of 26 minutes must be provided through direct physical encounter(s).
- For payment purposes, the service date of the claim must be the date on which all requirements of the service have been completed.
Maximum number of K133 payments per 12-month period
- A maximum of one K133 is payable per patient in a 12-month period.
- Only one of K133, K131 (periodic health visit – adult age 18 to 64) or K132 (periodic health visit – adult 65 and older) is eligible for payment per patient per physician per 12-month period.
Examples
Example 1a: Periodic health visit eligible for payment as K133
Zach is a 21-year-old male with a diagnosis of IDD who lives with his parents. Zach attends his family physician, Dr. Au’s office, for a periodic health assessment accompanied by his mother who is also Zach’s substitute decision maker.
Dr. Au completes some elements of history and physical examination between 09:30 to 09:45 that day, at which point Zach becomes restless and uncooperative. Dr. Au documents the patient findings and the start and stop time of the direct patient contact in the patient medical record.
Dr. Au schedules Zach for a second appointment one week later and completes the physical examination between 13:00 and 13:20, documenting the start and stop time and findings in the patient medical record. Dr. Au also delegates a COVID booster immunization to a nurse employee who administers the vaccine to Zach in Dr. Au’s office.
Three days later, Dr. Au completes a virtual visit with Zach and his mother, providing additional health maintenance counselling and outlining a comprehensive management plan based on the findings and current practice guidelines. This visit starts at 10:00 and ends at 10:20. Documentation is included in the patient medical record, including start and stop times.
What fee code(s) are eligible for payment to Dr. Au?
Explanation:
- As Dr. Au has provided (and appropriately documented) a periodic health assessment lasting a minimum of 50 minutes with an in-person component of more than 26 minutes for a patient with IDD, K133 is eligible for payment. Note that the service date of the claim must be the date on which all requirements of the service have been completed, which in this example is the date of the virtual visit.
- G593 is also payable to Dr. Au for the Covid immunization delegated to an employee with appropriate skill and training to perform this procedure and administered in Dr. Au’s office.
- Note that no other fee codes (such as G700, A001 or A007) are payable for the services described in this scenario.
Example 1b: Visit not eligible for payment as K133
13 months following the visit described in Example 1a, Dr. Au provides a virtual visit to Zach and his mother to review his health status, which has been stable. Zach and his mother are reluctant to attend an in-person visit.
What fee code(s) are eligible for payment to Dr. Au?
Explanation:
- As Dr. Au has not provided any in person assessment, K133 is not eligible for payment.
- Provided that Dr. Au has met the Schedule requirements, she may claim a virtual visit consistent with the assessment provided (for example A007 or A001 with the appropriate virtual modality indicator code).
Example 2: Periodic health visit not eligible for payment as K133
Pierre is a 50-year-old male with a history of spina bifida. Pierre does not have intellectual or developmental disability or delays.
Pierre attends his family physician, Dr. Ozier, for a periodic health visit for the first time in three years.
What fee code(s) are eligible for payment to Dr. Ozier?
Explanation:
- K131 (periodic health visit – adult age 18 to 64) is eligible for payment to Dr. Ozier.
- Although Pierre has a history of spina bifida, he does not have intellectual and developmental delay. Therefore, K133 is not eligible for payment.
Example 3: Periodic health visit not eligible for payment as K133
Serena is a 15-year-old non-verbal female with autism spectrum disorder with IDD who lives in a group home and attends her family physician, Dr. Connor’s, office for a health visit accompanied by her guardian.
Dr. Connor provides an in person periodic health assessment lasting 60 minutes, documenting her findings as well as the start and stop times in the patient medical record.
The visit includes appropriate counselling and a comprehensive management plan for Serena and her guardian.
What fee code(s) are eligible for payment to Dr. Connor?
Explanation:
- K130 (periodic health visit – adolescent) is eligible for payment to Dr. Connor.
- As Serena is not an adult, K133 is not eligible for payment.
Example 4: Visit not eligible for payment as K133
Ramesh is a 45-year-old male with a mild intellectual disability who lives independently in the community with some support from his family and friends.
Ramesh visits his family physician, Dr. Marais, for a periodic health assessment. The visit lasts 20 minutes and Dr. Marais claims K131 because the time requirement for K133 was not met.
Eleven months later, Ramesh attends Dr. Marais’ office for a pre-scheduled visit accompanied by his sister who has some questions about screening that Ramesh might require related to a family member’s recent diagnosis of colon cancer. Dr. Marais agrees that additional screening is required and orders appropriate testing. The visit lasts 50 minutes.
What fee code(s) are eligible for payment to Dr. Marais?
Explanation:
- Dr. Marais may claim K013 x 2 units for the educational counselling provided related to cancer risk, provided that Schedule rules have been met (including maximum number of units claimed/year).
- As another periodic health assessment (K131) has been claimed within the preceding 12 months, K133 is not eligible for payment.
Keywords/tags
OHIP Claims; OHIP Payment; Intellectual Disabilities: Developmental Disabilities; Disabilities; Periodic Health Visit
More Information
Contact information
For additional information, please visit the Resources for Physicians and the How to Get Help with Billing Questions pages on the ministry website.
If you have any billing or claims submission inquiries, please contact the Inquiry Services, Service Support Contact Centre (SSCC) by email or by calling
To provide feedback on EPC Billing Briefs, or to suggest topics for future EPC Billing Briefs, send an email to the attention of the joint MOH/OMA Education and Prevention Committee.
The Ministry of Health (MOH) and the Ontario Medical Association (OMA) have jointly prepared this educational resource to provide general advice and guidance to physicians on specific billing matters.
Note: This document is technical in nature and is available in English only due to its limited targeted audience. This publication has been exempted from translation under the French Language Services Act. For questions or support regarding this document, please contact the Service Support Contact Centre (SSCC) by email or by calling
Remarque : Ce document est de nature technique et est disponible en anglais uniquement en raison de son public cible limité. Ce document a été exempté de la traduction en vertu de la Loi sur les services en français. Pour toute question ou de l’aide concernant ce document, veuillez contacter Les Services de renseignements, Centre de contact pour le soutien des services par courriel ou en téléphonant le