April 17, 1998
|Direct inquiries to
Ministry of Health
Hospitals, Clinics, and Laboratories
TO MINISTRY OF
HEALTH SCHEDULE OF BENEFITS FOR PHYSICIANS’ SERVICES,
EFFECTIVE FEBRUARY 1, 1998 : MAXIMUMS AND UNIT-BASED SERVICES
|The attention of physicians is drawn to changes in the
Preamble of the Schedule of Benefits,
Part B, Section 11, effective February 1, 1998, that pertain to those services for which
payment of a maximum or minimum number services is stipulated and to those services which
are billed in terms of time units. Although physicians are encouraged to consult the text
of the Schedule itself, the following comments may assist physicians in understanding the
In many cases the Schedule has historically described payment of a service in
terms of a minimum or maximum number of services. When the number of services performed of a given type of service is fewer than the specified minimum number
of services or more than the specified maximum number of services, those services above or
below the respective thresholds remain insured services payable at nil and cannot be
billed to the patient. This is not new but is consolidated into the Preamble
for the convenience of those reading the Schedule. In effect, a physician must perform the
specified minimum number of services in order to receive payment, and any services beyond
the specified maximum are considered to be included in the fee paid for the maximum number
When physicians perform services for which time-based "units" are used in
submitting claims to OHIP (counselling, psychotherapy, surgical assisting, anaesthesia,
etc.), the time at which the service is commenced and is terminated must be recorded in
the patient’s medical record. If that information is not recorded, the physician is
not entitled to payment of the service. This requirement is new. The General
Manager of OHIP has the authority to request copies of medical records at any time for the
purpose of monitoring and controlling payment, and all physicians’ records may be
subject to further or other review by the Medical Review Committee.
30 Poyntz St.
119 King St. W
P.O. Box 2280, Stn. A
220-808 Robertson St.
1055 Princess St.
P.O. Box 9000
Canada Life Square
235 King St. E.,
217 York St., 5th FloorP.O. Box 5700
201 City Centre Dr.
P.O. Box 7020, Stn. A
101-447 McKeown St.
419 King St. W.
P.O. Box 635 L1H 8L4
75 Albert Street
981 2nd Avenue E.
550 Lansdowne St. W.
59 Church St
452 Christina St. N.
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 38