CHANGES TO OHIP-INSURED PHYSIOTHERAPY SERVICES EFFECTIVE APRIL 1, 2005.

Note: These amendments do not affect the provision of insured physiotherapy services that are currently provided by hospital for in-patients and out-patients, Community Care Access Centers and other physiotherapy services funded outside of OHIP.

(6) Claims Submission:

All claims must include the following documentation requirements for payment to be authorized by OHIP.

Effective April 1, 2005, all physiotherapy claim submissions must now include:
• a Specialty code “81” which replaces the previously used Specialty code “80”
• a valid Diagnostic Code for physiotherapy services
• a valid Referring/Requisitioning Health Care Provider Number of the physician who ordered the insured physiotherapy service
• a valid Ministry assigned Facility Number must be submitted with codes V826 and V831
• a valid Ministry assigned Facility Number must be submitted with code V827 when the service is provided to a LTC facility resident

Limitations are placed upon physiotherapy codes as follows:
• V822 and V826 are limited to one initial visit per patient
• V826, V827, V829, V830 V840 and V822 are limited to a maximum of 100 services per patient per fiscal year
• V831 is limited to a maximum of 50 services per patient per fiscal year

• Written records must be maintained pertaining to the insured physiotherapy services provided to an insured person and must include: the name of the insured person to whom the physiotherapy services were rendered, the dates when the physiotherapy services were rendered, the location, a detailed description of the services rendered on each date and at each location, the name or names and license or certificate of registration number issued by the College of Physiotherapists of the physiotherapist who actually rendered each service on each date and at each location.

This Bulletin is a general summary provided for information purposes only. Health care providers are directed to review the Health Insurance Act, Regulation 552 and the Schedules under that regulation, for the complete text of the provisions. You may access this information on-line at : http://www.e-laws.gov.on.ca. In the event of a discrepancy between this bulletin and the Act or regulations and/or Schedules under regulations, the text of the Act, regulations and/or Schedules prevail.

MOHLTC has provided some patient resources to help you inform your patients of changes to physiotherapy services. You may wish to post this material in your office or distribute this to your patients.