March 12, 2021 Update

The Ministry of Health has extended 5 existing temporary physician funding initiatives under OHIP to September 30, 2021 and November 28, 2021, as outlined below. Additionally, there are 2 new temporary physician funding initiatives for the period of March 14, 2021 to September 30, 2021, and 1 new temporary physician funding initiative for the period of October 1, 2020 to September 30, 2021.  Please see below for a summary.  Additional information can be obtained by accessing this link.

Assessment Centres

  • Continue the H409 and H410 sessional fees for physicians providing COVID-19 services at ministry-designated Assessment Centres to September 30, 2021

Virtual Care (“K-Codes”)

  • Continue the temporary OHIP virtual care fee codes (K080, K081, K082, and K083) for physician phone and video visits until September 30, 2021

Premiums and Management Fees for Virtual Care

  • Continue to enable the application of various existing premiums and management fees that relate to in-person visits to the temporary virtual care K-codes until September 30, 2021
  • New – Enable the payment of point of care drug testing urine tests (G040, G041, G042 and G043 fee codes) when done in association with a virtual visit

After Hours Premiums

  • Continue the temporary payment criteria for after hours procedure premiums E409 and E410 to November 28, 2021

AGMP Modifier Payments

  • Reactivate the E405A COVID Hospital Complexity Modifier for AGMPs in hospital retroactive to October 1, 2020 and until September 30, 2021

Focused Practice Psychotherapy Premium for Virtual Care

  • New – application of the existing focused practice psychotherapy premium for eligible physicians that relates to in-person psychotherapy to psychotherapy provided by phone or video using the K082 virtual care K-code for the period of March 14, 2021 to September 30, 2021

Virtual Care for Palliative Care

  • New – temporary OHIP virtual care fee codes specifically for palliative care physician services by phone and video, at equivalent rates to A945 and K023, are being created for the period of March 14, 2021 to September 30, 2021

Critical Care Premiums

  • New – COVID-19 temporary 30% premium (E415A) for life threatening critical care services G521, G522 and G523, in lieu of hospital hourly Protective or Pre-Emptive Code Blue Teams funding*, for the period of October 1, 2020 to September 30, 2021

*NB – PCB services started on December 15, 2020 at the Juravinski Hospital therefore, the 30% premium is not applicable for critical care services at JH from that time onward.

If registered with OTN (OHIP Virtual Care Physician & Dentist Registration Form), and using the OTN eVisit platform, you can bill an Assessment code plus a B tracking code, which is payable at 0.00.

There must be a Service Location Indicator Field in your billing software, and you must enter OTN in that field. OHIP does not know which platform is being used.

If using another platform, (eg Telus or REACTS), K codes must be used for billing.

It was mentioned that after COVID, K codes may disappear and we will need to use OTN with the B codes to bill virtual visits, but of course there is no timeframe for this and hopefully criteria for Virtual visits will be expanded in the coming months

COVID Codes (effective March 14, 2020)              

  • K080A: minor assessment of a patient by telephone or video, <10 minutes $23.75
  • K081A: intermediate assessment of a patient by telephone or video ≥ 10 minutes $36.85
  • K082A: primary mental health care, psychotherapy or psychiatric interview conducted by telephone or video $67.75

These codes are in basket.

They are eligible to be billed with Q012A (after hours premium and on weekend) if calling patient after hours or weekend/holiday.

New OTN Tracking codes (Effective April 01, 2020)

  • B103A (video visit when patient is physically located and supported at a patient host site) $0.00
  • B203A (video visit with a patient in the home or another location of their choice) $0.00

Bill appropriate OHIP code along with one of the above tracking codes.

Set Service Location Indicator (SLI) to OTN.    

Ministry confirmed details about both sets of codes.  Ticket # 496699, March 30 2020.

OTN applies to only rostered patients. In-basket codes are paid as in basket and likewise out of basket codes are paid as out of basket.

If you use OTN to see a non-rostered patient during COVID crisis, you can bill the K080A-K082A codes.

COVID applies to both rostered and non-rostered patients. 

Leave a Reply