Bulletin

Under the 2000 Agreement between the Ontario Medical Association (OMA) and the Ministry of Health and Long-Term Care (MOHLTC), the parties agreed to segregate technical fees of diagnostic services into a separate funding pool.  To facilitate this segregation, the option to submit claims for combined professional component P and technical component H or T using “A” suffixed fee codes, as described in the following ‘Background’ section and table, will be eliminated effective April 1, 2001. Claims for professional component P and technical component H or T must be submitted as separate claim items i.e. technical component H or T must be claimed using only the “B” suffix while professional component P must be claimed using only the “C” suffix. Claims for diagnostic services listed in the above table with a service date on or after April 1, 2001 and submitted as a combined fee using the “A” suffix option will be payable at nil.

BACKGROUND:  Fees for diagnostic procedures in the Nuclear Medicine, Diagnostic Radiology, Diagnostic Ultrasound and Pulmonary Function Studies sections of Schedule of Benefits for Physician Services are divided into a professional component P and a technical component  H or T.  When claims are submitted for diagnostic services in an Independent Health Facility (IHF) and a facility fee is listed in the Schedule of Facility Fees, physicians must submit claims for professional component P separately from the facility fees. However, when the diagnostic service is rendered in a hospital or non-IHF clinic, physicians have the option of submitting claims for professional and technical components either combined as one fee (using “A” suffix code) or separately (“B” suffix for technical component H or T and “C” suffix for professional component P). [Note: for non-diagnostic services, “A”, “B” and “C” suffixes are defined differently and are unaffected by this bulletin]. The specific diagnostic codes for which the “A” suffix option will be discontinued April 1, 2001 are listed in the following table.