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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.
- 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.
- 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.
- 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
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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