Ontario Mental Health Billing Guide 2026
Ontario mental health billing guide. Covers OHIP K-codes for psychiatrists, private insurance for psychologists and RPs, and OSP free therapy.
Key Takeaways
- OHIP covers psychiatrists and general practitioners (K-codes) for mental health services.
- Psychologists, RPs, and RSWs in private practice bill through insurance or self-pay.
- The Ontario Structured Psychotherapy (OSP) program provides free government-funded CBT.
- Insurance receipts must include practitioner registration numbers and session details.
OHIP K-codes for psychiatrists, private insurance billing for psychologists and registered psychotherapists, publicly funded programs, and documentation requirements, in one complete reference.
Who Can Bill What in Ontario
Key distinction: OHIP covers psychiatrists and physicians only. Psychologists, registered psychotherapists (RPs), and registered social workers (RSWs) in private practice bill insurance or self-pay, not OHIP.
| Professional | College | OHIP | Private Insurance |
|---|---|---|---|
| Psychiatrist (MD) | CPSO | Yes (K-codes) | Rarely |
| Physician / GP | CPSO | Yes (A/GP codes) | Rarely |
| Psychologist | CPO | No | Yes |
| Registered Psychotherapist (RP) | CRPO | No | Yes (most plans) |
| Registered Social Worker (RSW) | OCSWSSW | No | Yes (many plans) |
OHIP K-Codes for Ontario Psychiatrists
Psychiatrists bill OHIP using K-codes from the Schedule of Benefits. Common codes include:
- K007: Psychiatric assessment, less than 50 minutes.
- K008: Psychiatric assessment, 50 minutes or more.
- K029: Psychiatric consultation (requires referral).
- K040: Individual psychotherapy (20–45 min).
- K041: Individual psychotherapy (45+ min).
Documentation tip: OHIP audits may request clinical notes to substantiate billing. Recording validated outcome measures (PHQ-9, GAD-7) strengthens medical necessity documentation.
Private Insurance Billing
Major insurers (Canada Life, Sun Life, Manulife, Green Shield) cover psychotherapy and psychological services under extended health benefit plans. Annual limits typically range from $500 to $2,500.
What to Include on a Receipt:
- Practitioner name and College registration number.
- Patient name and date of birth.
- Service date and duration.
- Service description (e.g., "Individual psychotherapy").
- Fee charged and amount paid.
Publicly Funded Programs
- Ontario Structured Psychotherapy (OSP): Free government-funded CBT for adults with anxiety or depression. Accessed by self-referral or GP referral.
- CMHA Ontario: Free community mental health services including counselling and crisis support.
- Connex Ontario: 24/7 referral system for mental health and addictions (1-866-531-2600).
Frequently Asked Questions
Does OHIP cover therapy in Ontario?
OHIP covers mental health services provided by psychiatrists and GPs. It does NOT cover psychologists or RPs in private practice.
Can Ontario psychologists bill OHIP?
No. Psychological services are covered only when provided as part of a hospital or community mental health centre funded by the Ministry of Health.
Can registered psychotherapists (RPs) bill insurance?
Yes. Many extended health benefit plans cover CRPO-registered psychotherapists. Coverage varies by plan.
What documentation is needed for insurance billing?
Practitioners need to provide detailed receipts including registration numbers, session dates, and service types. Validated outcome measures (PHQ-9, GAD-7) are increasingly used for utilization reviews.