Ontario Health Insurance Plan

INFOBulletin

Temporary COVID-19 Vaccine Fee Code

Changes to the Schedule of Benefits for Physician Services (Schedule) in response to COVID-19 outbreak effective March 6, 2021


To: Physicians
Category: Physician Services
Written by: Health Services Branch, Ontario Health Insurance Plan Division
Date issued: March 5, 2021
Bulletin Number: 210301


To support the government's vaccine strategy and roll out, the Minister of Health has made an Order under the authority of subsection 45(2.1) of the Health Insurance Act to temporarily list as an insured service a new fee code for the provision of the COVID-19 vaccine.

This fee code is available to physicians administering the COVID-19 vaccine in settings that are not designated by the Ministry of Health (the Ministry) as a COVID-19 Assessment Centre. This would include non-mass vaccination settings, such as a primary care office.

This code comes into effect March 6, 2021.

Please Note: While payment for the provision of the service associated with this temporary fee code is effective March 6, 2021, system changes will be implemented over the coming months to process payment. As a result, the Ministry requests that physicians wait to submit claims for this code until further notice. Further information regarding this change will be forthcoming.

Temporary Fee Code

IMMUNIZATION

+ G593 COVID-19 vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $13.00

Notes:

  1. G593 is payable for the administration of each dose of vaccine when multiple doses are required to complete the initial vaccination series.
  1. G593 is not eligible for payment for subsequent booster COVID-19 vaccination doses.
  1. G593 is not eligible for payment to a physician for services rendered during any time period for which H409/H410 is payable to that physician.

[Commentary: Except as described in Note 3, when other insured services are rendered on the same day, by the same physician to the same patient as a COVID-19 vaccination, G593 is payable for the vaccination in addition to the other services if the services otherwise meet the Schedule of Benefits requirements.

Where the sole reason for the visit is to provide the vaccination service, G700 would also be payable.]

G593 is also added to the table in the Delegated Procedures section of the General Preamble as an Applicable Fee Code for "Injections and Immunizations."

Primary Care Contracts

The Ministry and the Ontario Medical Association (OMA) have agreed to amend Primary Care agreements to include a new temporary Q593 "sole visit premium COVID-19 PEM" at a rate of $5.60.

The new Q593 "sole visit premium COVID-19 PEM" is eligible for payment with the G593 "COVID-19 vaccine" when delivery of COVID-19 vaccination is the sole reason for the patients visit.

The G593 and Q593 will be out of basket in all primary care patient enrolment models. 

Physicians in the following Patient Enrolment Models are eligible to claim the new Q593 for both enrolled and non-enrolled patients:

  • Family Health Organizations
  • Family Health Networks
  • Group Health Center
  • Rural and Northern Physician Group Agreements
  • Weeneebayko Area Health Authority
  • Saint Joseph's Health Center
  • Toronto Palliative Care Agreements
  • GP Focus Care of the Elderly
  • GP Focus HIV
  • Homeless Shelter Agreements
  • Sioux Lookout Agreements
  • Community Sponsored Agreement/Blended Salary Model

Primary Care providers working in Assessment Centers are not eligible to claim the new G593 or the Q593 sole visit premium during the same time period they are working in a Ministry designated COVID-19 Assessment Center.

Family Health Group (FHG) and Comprehensive Care Model physicians will continue to claim the G700 "Basic fee-per-visit premium" with G593 "COVID-19 vaccine" (sole reason for visit). 

The new G593 "COVID-19 vaccine" is not eligible for the FHG Comprehensive Care Premium (10%).

Please Note: While payment for the provision of the service associated with this temporary fee code is effective March 6, 2021, system changes will be implemented over the coming months to process payment. As a result, the Ministry requests that physicians wait to submit claims for this code until further notice. Further information regarding this change will be forthcoming.

COVID-19 Vaccine Patient Facilitation Fee (Q007)

The Ministry has also established a new COVID-19 vaccine patient facilitation payment, effective March 6, 2021. Where a Public Health Unit or the province formally requests a physician or physicians to contact patients to assist in the registering/booking of their patients' COVID-19 vaccination or to provide direct assistance in completing patient consent or other documentation, a one-time fee of $6 dollars per patient will be payable.

Physicians will submit tracking code Q007 for each patient for whom this service is rendered. Upon Ministry confirmation of physician eligibility for this payment (the physician has been formally requested to carry out this activity), the Ministry will make a one-time lump sum payment for all eligible claims submitted.

By accepting this payment, physicians are deemed to agree with the terms and conditions regarding this payment, as follows:

  • Q007 is not payable where a physician only provides general information regarding how to access or register for a vaccination.
  • Q007 is not payable when the physician administers the vaccine to the patient and claims G593.
  • Q007 can only be billed once per patient for as long as the Ministerial Order for G593 is in effect.
  • Q007 is not payable for services personally rendered by the physician for the same time period H409/H410 is claimed.

Please Note: While payment for the provision of the service associated with this temporary fee code is effective March 6, 2021, system changes will be implemented over the coming months to process payment. As a result, the Ministry requests that physicians wait to submit claims for this code until further notice. Further information regarding this change will be forthcoming.

COVID-19 Vaccines Rendered at COVID-19 Assessment Centres

Please be reminded that physicians currently providing COVID-19 vaccination services at a Ministry designated COVID-19 Assessment Centre (mass vaccination site) may claim the temporary H409 and H410 sessional codes for remuneration. This includes any sites where a hospital or Public Health Unit coordinates COVID-19 vaccine delivery, and includes physicians deployed as part of a mobile team at an eligible COVID-19 Assessment Centre.

Vaccine delivery in a primary care office (or other non-mass vaccine setting) may be remunerated through the temporary H409 and H410 sessional codes when a hospital/ Public Health Unit is responsible for administrative operations and oversight of vaccine delivery (for example, determining operating hours, coordinating/renting space, coordinating staffing including physician scheduling, booking appointments etc.).

In these circumstances, upon agreement of the physician, the Ministry will designate the portion of the primary care office dedicated to vaccine delivery as a COVID-19 Assessment Centre for the duration of the vaccine service delivery to enable the sessional fee billing. 

Keywords/Tags

COVID-19; COVID-19 vaccine; G593, Q593, Q007

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