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K030, Q040 & K023: Which Chronic Disease Codes Can You Bill Together?

Chronic disease codes are some of the highest-value services in family medicine, and they share one rule that catches physicians off guard: they don't combine with assessment codes.

If you're seeing a diabetic patient and billing K030, you can't also bill an A007 for the same visit. The chronic disease code stands on its own. Here are the five rules that matter most.

1. Chronic disease codes stand alone

K030 (Diabetes Management), K029 (Insulin Therapy Support), K032 (Neurocognitive Assessment), K037 (Fibromyalgia), K022 (HIV Primary Care), K023 (Palliative Care Support), and G271 (INR Management) all carry the same exclusion: no other A or K codes on the same claim.

They also all exclude the smoking cessation codes (E079, K039, Q042), which is a common habit to carry over from periodic health exams where smoking cessation is billable.

What this means practically: the chronic disease visit is the visit. Deciding between K030 and A007 for a diabetes follow-up is a real decision, not a formality, and the chronic disease code is almost always the better-paying choice when the visit genuinely meets its requirements.

2. Q040: Bill the day after your third K030

The Diabetes Management Incentive (Q040) is one of the most commonly missed payments in family medicine, because the trigger is easy to lose track of across a year.

  • K030 is capped at 4 per patient per 365 days.
  • Once you've billed three K030s within 12 months, you bill Q040 after the third.
  • Q040 is capped at 1 per patient per 365 days.
  • Both require diagnostic code 250 (DM2).

The timing matters: Q040 goes after the third claim (e.g. the following day, with the 4th claim, etc.). Bundling it onto the same claim as the third K030 is one of the most common reasons this incentive gets rejected instead of paid.

Tracking three K030s across a year for every diabetic patient in a panel is exactly the kind of thing that gets missed on a busy day, and it's a straightforward loss when it does.

3. Only two chronic disease codes qualify for after-hours

The FHO After Hours Bonus (Q012) applies to K030 and Q050 (Heart Failure Incentive) and to nothing else in this category.

K029, K032, K037, K022, K023, and G271 do not qualify for Q012. If you're seeing chronic disease patients in an evening or weekend block, the after-hours premium only applies to diabetes management and heart failure.

4. Virtual eligibility varies more than you'd expect

There's no single rule here, so it's worth knowing the exceptions:

  • K032 (Neurocognitive Assessment) is not virtual eligible at all.
  • K030 is conditional: virtual only if the patient has had an in-person appointment within the last 12 months. This is easy to miss on a patient you've been managing remotely.
  • K029, K037, K022, and K023 are virtual eligible with K300 (video) or K301 (phone).
  • G271 (INR Management) is billed by phone by design and doesn't need a virtual modifier at all. It's billed per month.

5. What can ride along

The exclusions are broad, but a few things are still billable on the same claim, and they differ by code:

  • E080 (first visit after hospital discharge) works with all of them.
  • Pap and tray (G365/E430, or G394/E431) work with K030, K037, and K022.
  • Tests, vaccines, and procedures work with K030, K037, and K022.
  • K029, K032, K023, and G271 are the restrictive ones: E080 only.

Time-based codes: document accordingly

K029, K037, K022, and K023 are all time-based. Record your start and stop times.

K023 has a specific stacking rule worth knowing: if you've billed A945 or C945 and the visit exceeds 50 minutes, you can add K023 on top, with the clock starting after the first 50 minutes.

Don't forget the premiums

Three chronic disease premiums are worth checking your panel against:

  • Q050 (Heart Failure Incentive): rostered patients, max 1 per patient per 365 days, flow sheet required.
  • Q150 (FIT Counselling): ages 50–74, 1 per patient per 2 years, and rostering is not required. Covers determining eligibility and discussing instructions.
  • Q020/Q021 (Bipolar & Schizophrenia): an annual premium for rostered patients, billed with each visit, with any diagnostic code. Thresholds are more than 5 patients and more than 10 patients.

Prevent rejected combinations

Tracking three K030s across a year, catching the Q040 window, knowing which chronic disease codes take Q012 and which go virtual: Quip checks your billing history and flags the opportunities automatically, before your claim leaves the EMR.

Use Quip for free to see how it surfaces chronic disease incentives in real time, right inside PS Suite or Accuro.

Quip Medical builds AI-powered OHIP billing optimization for Ontario physicians. This post reflects billing rules as of July 2026; always confirm current requirements with the OMA Schedule of Benefits.