As the government is progressively rolling out the COVID-19 vaccine and reopening Ontario, temporary OHIP physician services funding is being extended until September 30th, 2022 in an effort to provide patients with continued access to health care. This extension is the result of an agreement between the Ministry of Health (ministry) and the Ontario Medical Association (OMA). On top of these funding initiatives, Temporary Physician Funding for Hospitals During COVID-19 will also extend until September 30th, 2022. To support health system planning, the Schedule of Benefits for Physicians Services (Schedule) will be amended with the changes on October 1st, 2021.
Existing Initiatives Being Extended
Assessment Centres (ACs)
- If you provide COVID-19 services at ministry-designed ACs, you’ll continue using H409 and H410 session fees until September 30th, 2022.
- For more information, you can refer to INFOBulletin 210305.
Virtual Care (“K-codes”)
- If you conduct phone and video visits, you’ll continue using the temporary OHIP virtual care fee codes (K080, K081, K082, and K083) until September 30th, 2022. Keep in mind that starting October 1st, 2021, these services will require a modality indicator tracking code. You’ll submit this code with the claim in order to identify whether you used phone or video to provide the service. Stay tuned for more information on claim submission with a modality indicator tracking code.
- For more information, you can refer to INFOBulletin 210403.
Virtual Palliative Care Services
- If you provide palliative care physician services by phone and video, you’ll continue using the temporary OHIP virtual palliative care fee codes (K092, K093, K094, and K095) until September 30th, 2022.
- For more information, you can refer to INFOBulletins 210403 and 210605.
Focused Practice Psychotherapy Premium for Virtual Care
- If you provide eligible virtual psychotherapy care, you’ll continue billing the temporary payment of the focused practice psychotherapy premium with K082 until September 30th, 2022.
- For more information, you can refer to INFOBulletin 210402.
Premiums and Management Fees for Virtual Care
- If you provide virtual care that is eligible for Age-Based Fee Premiums, Internal Medicine Office Assessment Premium, E078, E060, K630, K187, K188, or K189, and management fees K045, K046, K119, K481, Q040, K682, K683, K684, W010, you’ll continue to enable the application of these various premiums to the temporary virtual care K-codes until September 30th, 2022. This also applies to the payment of point of care drug testing (G040, G041, G042, and G043) when done jointly with a virtual K-code visit.
- For more information on application premiums and management fees, you can refer to INFOBulletin 210402. For more information on point of care drug testing, you can refer to INFOBulletins 210402 and 210404.
After Hours Procedure Premiums
- For after-hours procedure premiums E409 and E410, you’ll continue the temporary payment criteria until September 30th, 2022. This includes eligible elective surgeries and procedures.
- For more information, you can refer to INFOBulletins 201110 and 210402.
Aerosol-Generating Medical Procedures (AGMP) Modifier Payments
- For AGMPs performed outside of the hospital, you’ll continue using the temporary E404 modifier until September 30th, 2022.
- For AGMPs performed in the hospital, you’ll continue the temporary E405 modifier until September 30th, 2022.
- For more information, you can refer to INFOBulletin 210302.
Critical Care Premiums
- For life-threatening critical care services (G521, G522, and G523), rather than hospital hourly Protective or Pre-Emptive Code Blue Teams funding, you’ll continue using the temporary E415 premium until September 30th, 2022.
- For more information, you can refer to INFOBulletin 210303.
Staying up to date on the initiatives implemented by the ministry and OMA will ensure things run smoothly when submitting claims. The less time wasted on billing mistakes as a result of a lack of information, the more time you can spend providing your patients with the best care possible. If you have any questions about these amendments, feel free to get in touch with our team.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
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