Ontario Health Insurance Plan

OHIP Bulletins

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INFOBulletin

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

To: Group Health Centre Physicians
St. Joseph's Health Centre Physicians

Published by: Negotiations Branch, Ministry of Health

Date Issued: January 3, 2020

Bulletin Number: 11223

Re: Kaplan Board of Arbitration Award – Appropriateness Working Group (AWG): Arthroscopy Knee Surgery Changes to the Schedule of Benefits for Physician Services (Schedule) effective October 1, 2019 – November 1, 2019 Implementations

Posted Electronically Only

PDF Version

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Further to INFOBulletin #11216, Kaplan Board of Arbitration Award – Appropriateness Working Group (AWG): Changes to the Schedule of Benefits for Physician Services (Schedule) effective October 1, 2019, this bulletin outlines the impact of the Schedule changes on primary care payments. The changes involve new fee codes.

Primary Care Changes

New Fee Codes

The following two new fee codes were added to the Schedule effective October 1, 2019.

R699 – Knee Arthroscopy - (for non-degenerative disorders or acutely locked knee)

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) have now been updated to include these two new fee codes, effective October 1, 2019.
• Claims submitted by a physician in the GHC or SJHC with a service date equal to or greater than October 1, 2019, and that paid at $0 with explanation code ‘I2 – Service is globally funded’ after October 1, 2019, will be adjusted to pay fee for service (FFS). You will be notified through an INFOBulletin once the adjustment processing begins.
• Claims with a service date equal to or greater than October 1, 2019 and assessed in November 2019 or later will pay FFS and will not require adjustment.

For any further inquiries, please contact the Service Support Contact Centre at:
1-800-262-6524 or by email to Ministry of Health Service Support Contact Centre