OHIP Bulletin 4314

This bulletin provides a description of the changes to the Schedule of Benefits recommended by the Physician Services Committee to manage OHIP payments for physician services within the authorized fee-for-service budget. These changes are listed below under "Utilization Management". In addition to the utilization management changes, there are other changes which reflect a periodic update to Schedule contents following consultation with the OMA. These updates are listed below under "Other Changes".

1. UTILIZATION MANAGEMENT

A. Prenatal Ultrasounds
Prenatal ultrasound limited to maximum of 2 examinations per normal pregnancy including one complete examination on or after 16 weeks and one limited examination before 16 weeks for Maternal Serum Screening Program. Maximums do not apply to new codes for high risk or complicated pregnancies. Prenatal ultrasound examinations not included in above codes are not an insured service. Codes and descriptions on page G2 amended as follows:

	Pregnancy	H	P₁	P₂
	- Complete - on or after 16 weeks gestation
J159/J459	(maximum one per normal pregnancy)	48.80	29.10	21.80
J160/J460	- Complete - for high risk pregnancy or complications of pregnancy	48.80	29.10	21.80
J157/J457	- Gestational age for Maternal Serum Screening Program - before 16 weeks gestation (maximum one per normal pregnancy)	32.10	21.80	19.20
J158/J458	- Limited - for high risk pregnancy or complications of pregnancy	32.10	21.80	19.20

J163/J463 is amended as follows:

J163/J463	Pelvis, limited study - for other than pregnancy	32.10	21.80	19.20
J161/J461	Intracavitary ultrasound, limited - for other than pregnancy	32.10	21.80	19.20

Below J194/J464 Follicle Monitoring studies the Note is changed to read:

...Additional ultrasounds may be claimed as J164/J464.

B. Second Patient Special Visit Premiums

Special visit premiums are eliminated with the exception of visits to patients in the emergency department, hospital out-patient department or to hospital in-patients. SOB page xxi section B.5(d) iii is changed as follows:

(d)iii

Physician on Call: When an on-call physician practising.......... premium K99-. Submit claims for insured services rendered to all subsequent patients who arrive in the Emergency Department while the physician is still in the hospital or its environs, using the "H" prefix (H1_ codes) listings.

Page xxxvi section B.23 section (g) is replaced with the following: