Ministry of Health
SUBMISSION FOR E450, E451, “X”, “J” AND “Y”
PREFIXED DIAGNOSTIC SERVICES
NOTICE TO: HOSPITAL RADIOLOGY, ULTRASOUND, NUCLEAR MEDICINE
AND PULMONARY FUNCTION DEPARTMENTS AND PHYSICIANS RENDERING
SPIROMETRY OR FLOW VOLUME LOOP TESTING IN PRIVATE CLINICS
Under the 2000 Agreement between the Ontario
Medical Association (OMA) and the Ministry of Health and Long-Term
Care (MOHLTC), the parties agreed to segregate technical fees of
diagnostic services into a separate funding pool.
To facilitate this segregation, the option to submit claims
for combined professional component P and technical component H or
T using “A” suffixed fee codes, as described in the following
‘Background’ section and table, will be eliminated effective April
1, 2001. Claims for professional component P and technical
component H or T must be submitted as separate claim items i.e.
technical component H or T must be claimed using only the “B”
suffix while professional component P must be claimed using only
the “C” suffix. Claims for diagnostic services listed in the
above table with a service date on or after April 1, 2001 and
submitted as a combined fee using the “A” suffix option will
be payable at nil.
Fees for diagnostic procedures in the Nuclear
Medicine, Diagnostic Radiology, Diagnostic Ultrasound and Pulmonary
Function Studies sections of Schedule
of Benefits for Physician Services are divided into a
professional component P and a technical component
H or T. When
claims are submitted for diagnostic services in an Independent
Health Facility (IHF) and a facility fee is listed in the Schedule
of Facility Fees, physicians must submit claims for
professional component P separately from the facility fees.
However, when the diagnostic service is rendered in a hospital or
non-IHF clinic, physicians have the option of submitting claims
for professional and technical components either combined as one
fee (using “A” suffix code) or separately (“B” suffix for
technical component H or T and “C” suffix for professional
component P). [Note: for non-diagnostic services, “A”, “B”
and “C” suffixes are defined differently and are unaffected by
this bulletin]. The specific diagnostic codes for which the
“A” suffix option will be discontinued April 1, 2001 are
listed in the following table.
30 Poyntz St.
119 King St. W
P.O. Box 2280, Stn. A
220-808 Robertson St.
1055 Princess St.
P.O. Box 9000
1400 Weber St. E. Unit B2
217 York St., 5th FloorP.O. Box 5700 Terminal A
201 City Centre Dr.
P.O. Box 7020, Stn. A
101-447 McKeown St.
Exec. Tower, Oshawa Centre. 419 King St. W.
P.O. Box 635 L1H 8L4
75 Albert Street
981 2nd Avenue E.
550 Lansdowne St. W.
59 Church St 3rd Floor
452 Christina St. N.
|Sault Ste. Marie
Roberta Bondar Place
70 Foster Dr., Ste. 100
199 Larch St.,
435 James St. S. ,
38 Pine St. N., Ste. 110
2195 Yonge St.
P.O Box 1700 Stn. A
1427 Ouellette Ave.
P.O. Box 48