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Changes to the Schedule of Benefits for Physician Services
Questions and Answers

N193: Posterior fossa craniectomy and plugging of obex (to include decompression of Arnold Chiari malformation if present)
This service will now be billed using the existing fee (N129) but will also include an add on code (E901) with operating microscope.

J892 and J692: Overnight Sleep Studies (Level 3)
These codes are the lowest of 3 levels of sleep studies and are rarely billed. They are therefore being delisted.

  1. When will these changes be effective?

    These changes will be implemented in three phases. Services that will receive fee increases will have effective dates retroactive to April 1, 2003. Also at this time, the discount on technical services provided in physicians' offices will be eliminated.

    Effective July 1, 2003, a total of 21 new fee codes will be introduced and revisions to 124 existing codes will occur.

    Changes effective August 1, 2003 will rebalance sectional inequities by providing increases to 89 fee codes and introducing 2 new fee codes.
     
  2. Why are fee changes to address specialist inequities being communicated under a separate cover?

    Fee increases to 89 existing fee codes and the introduction of 2 new fee codes to balance specialty inequities in psychiatry, geriatrics, obstetrics and gynaecology, general surgery, internal medicine including rheumatology, and family medicine are effective August 1, 2003. The affected fee codes are not included in this bulletin and will be communicated under a separate cover on or before August 1st.
     
  3. How are these changes being communicated?

    The contents of the Schedule of Benefits for Physician Services under the Health Insurance Act will be replaced with a revised version for fiscal year 2003/04. Physicians will be receiving a copy of the new Schedule on or before July 1, 2003.

    A bulletin (#4403) which details the changes for fiscal year 2003/04 will accompany the revised Schedule and is also posted on the ministry’s web site at www.health.gov.on.ca.

    The August 1, 2003 changes and the alpha index for the July 2003 version of the Schedule of Benefits will be communicated under a separate cover

Ontario Ministry of Health and Long-Term Care
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