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Ontario Health Insurance Plan

OHIP Bulletins


INFOBulletin

Keeping Health Care Providers informed of payment, policy or program changes

Registered Nurse with Extended Class InfoBulletins

To:  All Health Care Providers

Published by:  Claims Services Branch

Date Issued:  April 25, 2017

Bulletin Number:  10060

Re: New Ministry of Community and Social Services (MCSS) Fee Schedule Codes - Appendix F

Posted Electronically Only

PDF Version Portable Document Format | 195 Kb | 


This bulletin is intended to provide information to physicians regarding changes to the Appendix F of the Schedule of Benefits for Physician Services (the Schedule).

The Ministry of Community and Social Services (the ministry) is simplifying the Ontario Disability Support Program (ODSP) medical review process by introducing a new form which will be easier for ODSP recipients to understand and for health care professionals to complete.

ODSP is a provincial social assistance program that provides income support, health care benefits and employment supports to eligible Ontario residents who have disabilities.

Medical reviews are used to determine whether a person continues to be a person with a disability under the eligibility requirements of ODSP.

In April 2017, the ministry will start to mail out the new Medical Review Package containing two forms (Medical Form Part A and Part B).

The chart below outlines the health care professionals registered in Ontario who may complete the Part A and Part B (Health Status Report (HSR) section and/or Activities of Daily Living Index (ADLI) section):

Health Care Professionals who can complete all or part of the Medical Review form Part A Part B - HSR Part B - ADLI
Physicians Yes Yes Yes
Optometrists Yes Yes Yes
Psychologists Yes Yes Yes
Psychological Associates Yes Yes Yes
Nurses Practitioners Yes Yes Yes
Audiologists No No Yes
Chiropractors No No Yes
Occupational Therapists (OT) No No Yes
Physiotherapists (PT) No No Yes
Registered Nurses (RN) No No Yes
Social Workers No No Yes
Speech Language Pathologists No No Yes

The following fees are paid to approved health care professionals upon completion of Part A and Part B:

FORMS CODE FEE
Completion of Medical Form Part A K057 $35
Completion of Medical Form Part B - Both HSR and ADLI K058 $125
Completion of Medical Form Part B - Only HSR K059 $100
Completion of Medical Form Part B - Only ADLI K060 $25

Physicians can submit claims through the OHIP claims system using the fee schedule codes noted in the table above.

Other approved health care professionals should submit an invoice to the Disability Adjudication Unit by mailing it to:

  • Ontario Disability Support Program
  • Disability Adjudication Unit
  • Box B18
  • Toronto, ON M7A 1R3

For more information on ODSP visit www.ontario.ca/socialassistance

Please note, the effective date for the new fee codes listed above is April 1, 2017, however the OHIP claims system will not be updated until May 2017, so physicians may begin to bill as of May 1, 2017.


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