-2-

Reduction Rate

33.3%

66.7%

75%

Payment amounts for services provided prior to April 1, 2001

GPs

$330,000

$355,000

$380,000

Specialists

$410,000

$435,000

$460,000

 

 

 

 

Revised payment amounts for services provided on or after April 1, 2001

GPs

$340,000

$365,000

$390,000

Specialists

$420,000

$445,000

$470,000

Calculation of Threshold Reduction

The method of calculation is unaffected except that each threshold level has increased by $10,000. The reductions are calculated at the percentages above as physicians reach the level of payments noted. However, to reach those payment amounts, the actual billings are higher since payments are reduced once the threshold is reached. The calculations take these reduction amounts into account prior to determining the level and percentage deduction to apply. The new total billing amounts that correspond to each revised payment level above are shown below.

Reduction Rate

33.3%

66.7%

75%

Billed amounts for services provided on or after April 1, 2001

GPs

$340,000

$377,500

$452,500

Specialists

$420,000

$457,500

$532,500

1.3          Discontinue Combined Billing Submission for Diagnostic Professional and Technical Fees

 The "A" suffix billing option for diagnostic services is discontinued on or after April 1, 2001. Claims for H, T and F fees and P-fees must be submitted as separate claim items, i.e., H, T and F fees must be claimed using the "B" suffix, and P-fees must be claimed using the "C" suffix. Claims for diagnostic services listed in the table below, with a service date on or after April 1, 2001 and submitted as a combined fee using the "A" suffix option, will be paid at nil. See Bulletin #4364 "Claims Submission for E450, E451, X, J and Y Prefixed Diagnostic Services".

 Note: In all other sections of the Schedule, the "A" suffix continues to indicate a professional fee submitted by the attending physician who renders the procedure. Use of "A" suffix in this context is not subject to this change.

Fee Code

Description

X001 to X230

Diagnostic radiology in hospitals

J102 to J893*

Diagnostic ultrasound, nuclear medicine, sleep studies and pulmonary function studies in hospitals

Y602 to Y888

Nuclear medicine studies with data manipulation in hospitals

J301, J304, J324, J327

Spirometry and flow volume loop testing in both hospitals and private offices or clinics

E450, E451

Add-on codes to graded exercise pulmonary function studies in hospitals

* Does not include J001 to J068 clinical radiology procedures for which the clinical fee is not assigned.

1.4    Increase to After Hours and Special Visit Premiums

 After hours and special visit premiums are increased as follows. This increase includes the 2% increase to the Schedule of Benefits fees.

 Surgical Assistants' Services

 General Preamble, Section 20 (d), after-hours premiums payable when a case commences

E400B

Evenings (18:00h - 24:00h) Monday to Friday or daytime and evenings on Saturdays, Sundays, Holidays. Premium increased from 45% to 47.5%.

E401B

Nights (00:00h - 07:00h). Premium increased from 62.5% to 68.75%.

General Preamble, Section 20 (e), special visit premiums payable when a physician is required to make a special visit to assist at non-elective surgery with sacrifice of office hours for a case commences


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