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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:

G210 G391 G401 G406 G522 G558 G601 G604 G620
G211 G395 G402 G407 G523 G559 G602 G610 G621
G303 G400 G405 G521 G557 G600 G603 G611 G800-06

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.

Effective Date

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.

SRI Program

The ministry is in the process of reviewing SRI Program applications and will communicate with all applicants regarding the impact of these changes.

Communication

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.

 


Ontario Ministry of Health and Long-Term Care
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