Regulation 552 under the Health Insurance Act was amended on February 11, 1998 to
ensure that certain lab tests performed at the request of Extended Class Registered Nurses
(ECRNs) - (Nurse Practitioners) are insured services. Referrals on or after February 11,
1998 will be honoured by OHIP.BACKGROUND:
As a result of an agreement between the Ministry of Health and the College of Nurses,
ECRNs who are licensed by the College of Nurses of Ontario and registered with the
Ministry of Health can order specific medical laboratory tests.
Nurse Practitioners are registered nurses who have additional nursing education and
hold a certificate as an ECRN. This education prepares them to provide the public with
services in all five components of comprehensive health services; (health promotion,
prevention of diseases and injuries, cure rehabilitation, and support services). Although
ECRN’s services are different, they complement those provided by family physicians
and other primary care providers.
SYSTEM CHANGES:
System changes have been made to the Ministry’s Health Resources Register to
accommodate the registration of these practitioners. The nurse practitioners registration
numbers range from (722900 - 744292) with a specialty code (76). These services are for
referrals only and do not permit claims submission to OHIP by ECRNs for medical laboratory
tests.
Lab tests originating in a hospital cannot be billed to OHIP (see Bulletin 4218) and
remain the financial responsibility of the hospital.
For OHIP payment of lab tests ordered by ECRNs, the billing provider must be a Private
Medical Laboratory (5000 series) and the Fee Schedule Codes must be:
L005 L016 L030 L031 L040 L045 L053 L055 L067 L093 L107 L111 L117
L139 L148 L157 L181 L191 L194 L204 L208 L215 L221 L222 L223 L226
L243 L252 L253 L254 L306 L309 L311 L315 L316 L319 L321 L324 L329
L341 L345 L372 L377 L395 L396 L397 L398 L399 L417 L418 L419 L445
L452 L462 L481 L482 L490 L493 L500 L544 L622 L624 L625 L626 L627
L628 L629 L630 L631 L634 L640 L641 L643 L650 L651 L652 L653 L654
L655 L667 L668 L679 L683 L691 L710 L713 L716 L700.
