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4. Diagnostic and Therapeutic Procedures:  Otolaryngology - Diagnostic Hearing Tests

Fee code listings for Diagnostic Hearing Tests (DHT) are separated into "Basic Diagnostic Hearing Tests" and "Advanced Diagnostic Hearing Tests".

Basic diagnostic hearing tests are insured services payable at nil unless:

i.       the professional component is rendered personally by a physician qualified by appropriate education or training and experience to perform basic DHTs ('qualified physician'); and

ii.      the technical component is either rendered by a qualified physician or delegated by a qualified physician to a person who is either an appropriately qualified employee of the physician or is an audiologist who is a member of the College of Audiologists and Speech-Language Pathologists of Ontario and employed by a public hospital.

Advanced diagnostic hearing tests are insured services payable at nil unless:

i.       the professional component is personally rendered by an otolaryngologist or, for evoked audiometry, a neurologist or by a non-certified physician with equivalent post-graduate academic training ('appropriate specialist or equivalent'); and

ii.      the technical component is personally rendered by an appropriate specialist or equivalent, or delegated by an appropriate specialist or equivalent to an audiologist who is a member of the College of Audiologists and Speech-Language Pathologists of Ontario and is employed by the appropriate specialist or equivalent or a public hospital.

Physicians submitting claims for diagnostic hearing tests shall maintain written records of appropriate qualifications as indicated above for themselves and those employees to whom they may delegate the technical component. Such records must be made available to the Ministry on request. In the absence of such records, the DHT is an insured service payable at nil.

To qualify for payment, delegated DHT services must comply with the requirements for delegation of insured services described in General Preamble B.10 and the standards, guidelines and current policy statement of the College of Physicians and Surgeons of Ontario regarding delegation and supervision of controlled medical acts.

Fixed level screening audiometry is not an insured service.

DHTs at the request of or arranged by third parties, e.g. school boards, employers or WSIB etc., are not insured services. See Appendix F regarding third party services.

Automatic impedance audiometry is redefined to include manual testing methods at the automated testing rates. Separate fee codes for Manual Impedance Testing codes are deleted.

The fee for the professional component of sound field audiometry is reduced.

Advanced testing is redefined to include miscellaneous advanced testing.

Hearing aid (re)evaluation and/or tinnitus masker (re)fitting are de-listed as these services fall within the discipline of audiology and it is not necessary for a physician to provide or supervise these services. These changes permit more effective allocation of physician resources by redirecting care that does not require the assessment or intervention of a physician.

5.      General Preamble:  Maximums and Unit Based Services

This section is revised to clarify that maximum and unit based services that are rendered to patient in excess of the allowed maximum frequency and/or units are insured services payable at nil.

In terms of a minimum number of services without reference to a specific time period to which the minimum applies, this means that the minimum refers to a minimum number of services per patient per day. Those services rendered by the same physician which total less than the minimum remain insured services and are payable at nil. This does not apply to those services listed in the "Diagnostic Radiology" section of the Schedule.


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