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Changes to Payment Thresholds for Ontario Physicians
Additional Exclusions to Thresholds
Acute care "C" prefix hospital in-patient services including the listings for consultations, assessments and visits rendered to registered bed patients for services billed with a "C" prefix are excluded from the threshold.
The following critical care codes are also exempted from the threshold:
The General Preamble, Appendix E has been updated to reflect these new exclusions. Please note, the General Preamble, Appendix E pages 3E and 4E are dated March 31, 2003, for identification purposes only.
These changes are effective for fiscal year 2002/03. The new threshold payment system will be applied automatically to all claims submissions for services provided between April 1, 2002 to March 31, 2003 as early as April Remittance Advice.
The ministry is in the process of reviewing SRI Program applications and will communicate with all applicants regarding the impact of these changes.
Bulletins and the updated version of the Schedule are available on the Ministry of Health and Long-Term Care web-site at www.gov.on.ca/health/. These Schedule pages will be mailed separately.