Ontario Health Insurance Plan

INFOBulletin

COVID-19 Hospital Physician Compensation: E405A Changes

A system solution was implemented to allow the E405A to pay when submitted with E023C

To: All Providers
Category: Physician Services
Written by: Claims Services Branch, Ontario Health Insurance Plan Division
Date issued: November 12, 2020
Bulletin Number: 201105

Further to INFOBulletin 4758, the Ministry of Health (the ministry) implemented temporary payments for specified physician services provided in hospital as a result of the COVID-19 outbreak.

Fee Schedule Code (FSC) E405A: COVID Hospital Complexity Modifier was implemented on June 1, 2020 with an effective date of April 3, 2020.

An issue occurred during the implementation of this FSC where E405A was paying at $0 with explanatory code ‘DF â€“ corresponding fee code has not been claimed or was approved at zero’ when submitted with E023C.

Effective November 1, 2020, a system solution will be implemented to allow the E405A to pay when submitted with E023C.

Claims for E405A submitted with E023C that previously paid at $0 for service dates from April 3, 2020 to July 31, 2020 will be manually adjusted by the ministry. Adjustments will appear on future RAs.

Therefore, no action is required by physicians for previously submitted claims of E405A with E023C. Any new claims with service dates on or between April 3, 2020 and July 31, 2020 submitted for these services on or after November 1, 2020 will pay accordingly.

Please be advised that another issue has been discovered where E405A is not paying with some anaesthesiology extra unit fee codes related to American Society of Anaesthesiology (ASA) physical classification. The ministry is currently looking into this issue, and physicians will be advised of any system changes through a separate INFOBulletin.

Keywords/Tags

E405A; E023C; COVID-19; Hospital Complexity

For more information

For any further inquiries, please contact the Service Support Contact Centre via email or by phone at 1-800-262-6524.

The latest version of the Schedule of Benefits for Physician Services is available on the Ministry of Health website. Hard copies of the Schedule of Benefits for Physician Services will not be distributed. If you would like to order a paper copy or compact disk (CD) of the Schedule for a fee, please visit Publications Ontario. Physicians without access to the Internet can contact ServiceOntario at 1-800-668-9938.

This bulletin is a general summary provided for information purposes only. Physicians are directed to review the Health Insurance Act, Regulation 552, and the schedules under that regulation, for the complete text of the provisions. You can access this information at ontario.ca/laws. In the event of a conflict or inconsistency between this bulletin and the applicable legislation and/or regulations, the legislation and/or regulations prevail.

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