Bulletin

   
Bulletin Number
        4364
Date
        March 6, 2000
Direct inquiries to

         Ministry of Health
         Processing Office


(address below)
Distribution
       Physicians, Hospitals, Clinics, Laboratories
Subject     

CLAIMS 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.

BACKGROUND:  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.

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