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