OHIP-Covered Psychotherapy: What the Rules Actually Say

You will never see a fee code and you will never be billed. We publish them because they are the evidence. Almost every page that says therapy is covered by OHIP asserts it without pointing at anything; the codes below are the actual mechanism by which the province pays for therapy, and you can check them yourself in the Schedule of Benefits for Physician Services.

They are also practically useful in one specific way. If you are unsure whether a service someone is offering you is insured, the question "is this billed to OHIP as an insured service?" is answerable, and the answer determines whether you can be charged.

The Schedule defines psychotherapy as treatment for mental illness, behavioural difficulties or problems assumed to be emotional in nature, where a physician deliberately establishes a professional relationship with the patient in order to remove or modify symptoms, change disturbed patterns of behaviour, and support personality growth and development.

Two things follow from that wording. The first is that the physician requirement is in the definition itself, not in a separate eligibility rule. The second is that the definition is about the therapeutic relationship rather than about any particular school of therapy. Cognitive behavioural therapy, psychodynamic therapy and other approaches are all billed under the same codes.

These services are billed in units. The listings define a unit as a half hour or the major part of one. The General Preamble is more exact: the services are calculated in 30-minute time units, and it sets out the minimum direct contact time between patient and physician that each unit requires.

A commentary in the same section adds that a service of less than 20 minutes does not constitute any of the services in this section, and is instead billed as whatever type of assessment was rendered in the circumstances.

This is why a brief mention of your mood at the end of an appointment about something else is not psychotherapy in the billing sense. It also explains why physicians who practise psychotherapy tend to schedule dedicated appointments rather than adding therapy to a general visit.

Note the difference between the psychotherapy codes and the counselling codes. The counselling codes carry an explicit twelve-month rule. The first three units of K013 and K040 combined, per patient per provider in a twelve-month period, are paid at the higher amount; additional units are billed under K033 at the lower one. This is a fee reduction rather than a hard cap, the service remains insured either way, and it applies to counselling, not to psychotherapy.

A widespread belief is that OHIP allows a fixed number of therapy sessions a year and then stops. The Schedule does not contain such a rule for the individual psychotherapy codes. We checked every occurrence of K005, K007, K190, K197, K198 and K199 in the current Schedule, and none is subject to an annual, twelve-month or lifetime per-patient maximum. The only quantity limits attached to these codes are per-day limits on group psychotherapy.

Read that precisely. It means the billing rules do not name an annual ceiling. It does not mean sessions are unlimited, guaranteed, or an entitlement. The Schedule governs what the province pays a physician; it does not oblige any physician to take you on or to offer a particular number of appointments. How much therapy you receive is a clinical decision, and it depends on a physician having capacity.

The distinction still matters when you are weighing your options. If you assume covered therapy is capped at a handful of sessions, paying privately looks like the only route to longer treatment. The fee schedule does not impose that cap. Supply does: there are few physicians practising psychotherapy, and finding one with capacity is the genuine obstacle.

The counselling codes are the contrast that proves the point. Where the Schedule intends a twelve-month restriction, it says so explicitly, as it does for K013 and K040.

The Schedule contains a focused practice psychotherapy premium, set out in the General Preamble. It is payable automatically to an eligible physician. Where payments for qualifying psychotherapy services in the qualifying fiscal year exceed 50 percent of all payments made to that physician in the same year, the amount payable for a listed set of psychotherapy codes is increased by 17 percent for the following twelve months. A second route covers physicians at 40 to 49 percent who met the 50 percent test in the preceding year.

The premium is the province's own recognition that practising psychotherapy full time is a distinct kind of medical practice, deliberately supported through payment policy. If you have ever wondered whether "a doctor who does therapy" is a real category in Ontario, this is the answer.

The Schedule splits virtual care into two streams, and the difference matters. Comprehensive Virtual Care Services are those delivered where an existing or ongoing patient-physician relationship exists. In that stream, video is paid at the fee equivalent to the corresponding in-person service, and telephone is paid at 85 percent of the in-person fee, with an explicit exception: K005, K007, K197 and K198 are paid at 95 percent. Claims carry a modality indicator, K300A for video and K301A for telephone.

Limited Virtual Care Services are those delivered where no such relationship exists. These are billed under their own assessment codes rather than the psychotherapy codes, at materially lower amounts.

The practical consequence is that a physician elsewhere in Ontario can treat you without either of you travelling, which in much of the province is the only realistic route to insured psychotherapy. It also explains why a physician taking you on for therapy will want to establish an ongoing relationship rather than treat you as a one-off virtual contact.

Anyone who is not a physician

The word psychotherapist does not appear in the Schedule of Benefits. Neither psychologists nor registered social workers are listed as providers who can bill these codes. See the profession-by-profession answer.

Sessions under twenty minutes

They do not constitute any of the services in this section, and are billed as whatever type of assessment was rendered instead.

Therapy on the same day as an assessment

The General Preamble states that psychotherapy performed outside a hospital, psychiatric care, primary mental health care and hypnotherapy are not eligible for payment when rendered on the same day as a consultation or other assessment by the same physician to the same patient, unless there are clearly defined different diagnoses for the two services. The psychotherapy listings carry a matching note worded around the same patient visit.

Anything a private platform sells you

Unless the person delivering care is a licensed physician. Wording such as "covered" on a commercial site often refers to private insurance, not OHIP.

The figures on this page were transcribed from the Schedule of Benefits published 22 July 2026 and effective 1 July 2026, which is the version currently in force. Every fee and rule was re-checked against that document on 4 September 2026, and compared against the schedule effective 1 April 2026. Nothing relevant to this page changed between the two.

Where to find each item in the document:

• Definitions, the time-unit table, the same-day rule and the focused practice premium: General Preamble, pages GP54 to GP57.
• Primary mental health care and counselling codes: page A21.
• Psychotherapy codes for family practice: page A24.
• Psychiatry codes and premiums: pages A187 to A190.
• Virtual care payment rules: page A69.

Page references are specific to this version. The psychiatry listings moved from page A189 to A190 between the April and July schedules even though the fees did not change.

The Schedule is amended periodically and these amounts change. If you find a discrepancy between this page and the current Schedule, the Schedule is right and we want to hear about it through the corrections section of our editorial policy.