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Bulletin Number

N/A

Date

March 26, 2004

Direct inquiries to

Ministry of Health and Long-Term Care Processing Office

(See Address Below)
Distribution

Hospital Administrators

Subject

NEW INTERPROVINCIAL OUTPATIENT RATES EFFECTIVE APRIL 1, 2004

INTERPROVINCIAL OUTPATIENT HOSPITAL RATES

At their January 15, 16, 2004 meeting, the Interprovincial Health Insurance Agreements Coordinating Committee (IHIACC) Members agreed upon new rates for interprovincial outpatient services, provided on or after April 1, 2004.  The new rates are effective April 1, 2004.   Regional MOHLTC Finance Managers have previously distributed the new outpatient billing rates to individual hospitals.   Attached is a list of the outpatient billing rates for April 1, 2004.

The current billing principle of “multiple services – one rate” will continue to apply, namely billing for the outpatient service with the highest rate only when more than one service is received during an outpatient visit or on a given day.  Contact your local Ministry Regional Finance Manager for further information on rates.

Please note that the current rate of $400 for service code 02 – day surgery has not changed, and will continue, pending a review of day surgery rates by the Rate Review Working Group (RRWG).  However, you will recall that as of January 1, 2004, provinces and territories agreed to provide clinical data, i.e. procedure and diagnostic codes, in support of all day surgery claims.

As well, the current billing policy for service codes 06 and 07 – administration of chemotherapy and other drugs also continues, pending examination of this billing policy by the RRWG in the context of their upcoming day surgery rate review.

Finally, with regard to the service code 13 – defibrillator-pacemaker replacement, this service code now includes all types of pacemakers.