1. All consultations and visits for management and supervision of chronic dialysis treatments regardless of frequency, type or location of service and includes chronic dialysis of hospital inpatients.
  2. All consultations and visits within the scope of practice of nephrology and general internal medicine for assessment and treatment of complications of chronic dialysis and management of end stage renal disease and its complications in chronic dialysis patients.
  3. All related counselling, interviews, psychotherapy of patients and family members;
  4. All related case conferences.

The team fee does not include:

  1. Assessments and special visit premiums for emergent calls to the emergency department.
  2. Admission assessments and subsequent visits to acute care hospital in-patients for treatment of complications of dialysis, chronic renal disease or intercurrent illness.
  3. Any other diagnostic and therapeutic procedures, including acute dialysis treatments.
  4. Consultations and assessments by specialists in other than internal medicine or internal medicine sub-specialists other than nephrologists.
  5. Primary care by the patient’s family physician.
  6. Assessment by a renal transplantation specialist for entry into a transplantation program.
  7. Intermittent chronic hemodialysis treatment at an auxiliary treatment centre if fewer than three dialysis treatments are rendered to the patient in the 7-day period referred to above.
Chronic dialysis weekly team fee - claim the code representing the predominant location and modality
#G860 - hospital hemodialysis 123.32
#G861 - hospital peritoneal dialysis 123.32
#G862 - hospital self-care or satellite hemodialysis 123.32
#G863 - independent health facility hemodialysis 123.32
#G864 - home peritoneal dialysis 123.32
#G865 - home hemodialysis 123.32
#G866 Intermittent hemodialysis - at an auxiliary treatment centre (per treatment, maximum 2 per patient per 7-day period referred to above) 59.80
Note:

 

Where 3 or more treatments are rendered per 7-day period at an auxiliary treatment centre, the service comprises the chronic dialysis weekly team fee paid at the full amount, regardless of the number of treatments rendered.

I. Sleep Studies
Sleep studies services are redefined with technical component H and professional components P1 and P2. The following is the text of the new section within Diagnostic and Therapeutic Procedures:

SPECIFIC ELEMENTS
The technical component H of the procedure is payable only for services provided in the out-patient department of a hospital or in an off-site premise operated by the hospital corporation that has received approval under section 4 of the Public Hospitals Act.
The specific elements for the technical component H include the specific elements for the technical component of non-invasive diagnostic procedures listed in the Preamble to Diagnostic and Therapeutic Procedures.

OTHER TERMS AND DEFINITIONS

  1. For the services rendered outside a hospital setting the only fees payable under the Health Insurance Act are listed under the column P (use suffix C). Fees for the technical component of these services are only payable under the Independent Health Facilities Act.
  2. Fees for the technical component of services rendered in an Independent Health Facility are listed in the Schedule of Facility Fees.
  3. For services provided for hospital out-patients, the total benefit is arrived at by adding H plus P1 (first code listed,
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Ontario Ministry of Health and Long-Term Care
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