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Common Elements

Provision of the premises, equipment, supplies and personnel for the common elements of the service are included in the fee payable for the service. Any charge to the patient is extra-billing and subject to action under the Health Insurance Act and the Health Care Accessibility Act. For additional information regarding the common elements of insured services, refer to the Schedule General Preamble, Section B.1. Refer to the note below regarding administration of privately obtained vaccine.

Diagnostic Code

The Public Health Branch will be evaluating the effectiveness of the influenza vaccine. Therefore, physicians are directed to enter diagnostic code 487 in the diagnostic code field on the item record of the claim for all claims related to the diagnosis and treatment of influenza and its complications.

Publicly Funded Vaccine

All Ontarians are eligible to receive publicly funded influenza vaccine. However, the Public Health Branch of the Ministry of Health and Long-Term Care can release the publicly-funded vaccine in stages and/or direct physicians to administer the available supply to different population groups at different times in order to give priority to people with the highest risk of contracting influenza.

Privately Obtained Vaccine

Physicians may choose to purchase a private supply of the influenza vaccine to accommodate patient convenience. In this situation, administration of the vaccine remains insured. The physician can charge the patient for the vaccine in accordance with the Health Insurance Act, Regulation 552, section 24(4). However, physicians should advise patients of the availability of publicly funded vaccine which they are eligible to receive at no cost. Physicians should also be familiar with provisions under the Medicine Act applicable to the dispensing and sale of drugs.

Inquiries

 

·     Inquiries from physicians regarding fee-for-service claims submissions should be directed to the physician's local OHIP claims processing office.

 

·     Inquiries from public agencies and facilities should be directed to the local Public Health Unit.

 

 

·     Related Public Health Branch Bulletins are available on the web at : http://www.health.gov.on.ca/english/providers/program/pubhealth/flu/professionals/flu_bul/flubul_mn.html


Ontario Ministry of Health and Long-Term Care
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