Ontario Health Insurance Plan
OHIP Bulletins
INFOBulletin
Keeping Health Care Providers informed of payment, policy or program changes
To: Primary Care Physicians
Published by: Negotiations Branch, Ministry of Health
Date Issued: October 7, 2019
Bulletin Number: 11216
Re: Kaplan Board of Arbitration Award - Appropriateness Working Group (AWG): Changes to the Schedule of Benefits for Physician Services (Schedule) effective October 1, 2019 - UPDATE
Posted Electronically Only
Further to INFOBulletin #11214 Kaplan Board of Arbitration Award - Appropriateness Working Group (AWG): Changes to the Schedule of Benefits for Physician Services (Schedule) effective October 1, 2019, the following revisions have been made to the implementation timelines for the following primary care changes:
Primary Care Changes
This bulletin outlines the impact of the Schedule changes on primary care payments. The changes involve new fee codes and removed fee codes.
New Fee Codes
The following new codes have been added to the Schedule effective October 1, 2019.
Z292, Z293 – Laryngoscopy
- The list of Excluded Codes for the Group Health Centre (GHC) will be updated at a later date to include the two new fee codes, effective October 1, 2019.
- Until the update is completed, if either of the two new codes are submitted by a physician in the GHC with a service date equal to or greater than October 1, 2019, the claim will pay $0 with explanation code ‘I2 – Service is globally funded’.
- When the Excluded Code list is updated, claims submitted with a service date equal to or greater than October 1, 2019 will be adjusted to pay FFS.
R699 - Knee Arthroscopy - (for non-degenerative disorders or acutely locked knee)
- The Excluded Code lists for the Group Health Centre (GHC) and for St. Joseph`s Health Centre (SJHC) will be updated at a later date to include the new fee code, effective October 1, 2019.
- Until the update is completed, if this code is submitted by a physician in the GHC or SJHC with a service date equal to or greater than October 1, 2019, the claim will pay $0 with explanation code ‘I2 – Service is globally funded’.
- When the Excluded Code lists are updated, claims submitted with a service date equal to or greater than October 1, 2019 will be adjusted to pay FFS.
E498 - Knee Debridement - (debridement of focal, symptomatic post-traumatic cartilage flap)
- The Excluded Code lists for the Group Health Centre (GHC) and for St. Joseph`s Health Centre (SJHC) will be updated at a later date to include the new fee code, effective October 1, 2019.
- Until the update is completed, if this code is submitted by a physician in the GHC or SJHC with a service date equal to or greater than October 1, 2019, the claim will pay $0 with explanation code ‘I2 – Service is globally funded’.
- When the Excluded Code lists are updated, claims submitted with a service date equal to or greater than October 1, 2019 will be adjusted to pay FFS.
Further information regarding the implementation dates for each of these changes will be forthcoming.
For any further inquiries, please contact the Service Support Contact Centre at 1-800-262-6524.
Public Information
