Ontario Health Insurance Plan

INFOBulletin

COVID-19 Temporary Premium for Life Threatening Critical Care

Fee code E415A is a 30% premium for Life Threatening Critical Care fee codes G521, G522 and G523, effective October 1, 2020.


To: All Providers
Category: Physician Services
Written by: Claims Services Branch, Ontario Health Insurance Plan Division
Date issued: March 3, 2021
Bulletin Number: 210303


New Premium for G521, G522 and G523 Fee Codes

To further support the government's efforts to stop the spread of COVID-19 in Ontario, the Ministry of Health (ministry) and the Ontario Medical Association (OMA) have reached an agreement to implement a new option for hospitals as an alternative to reactivating the Protected Code Blue or Pre-Emptive Protected Code Blue response team funding.

On March 1, 2021 the ministry implemented a new temporary life threatening critical care premium fee code E415A with an effective date retroactive to October 1, 2020 and in effect until September 30, 2021.

Hospitals will now have the option to have physicians receive a new temporary 30% premium for the following eligible Life Threatening Critical Care codes:

  • G521 first 1/4 hour (or part thereof)
  • G522 second 1/4 hour (or part thereof)
  • G523 after fist 1/2 hour, per 1/4 hour (or part thereof)

Physicians can submit this premium for services provided in the hospital for patients requiring resuscitation including endotracheal intubation, who are COVID-19 positive or who are treated as at-risk of being COVID-19 positive under local hospital policy. The physician(s) providing the resuscitation and/or endotracheal intubation are eligible to submit the premium.

For clarity, physicians cannot receive payment of the new temporary Life Threatening Critical Care premium if their hospital has chosen the option of reactivating their Protected Code Blue or Pre-Emptive Protected Code Blue response team funding. Hospitals can only utilize one of the funding approaches for Protected Code Blue or Pre-Emptive Protected Code Blue response teams.

This temporary premium is only for services rendered between October 1, 2020 and September 30, 2021. This E415 modifier fee code must be submitted with fee codes G521, G522, and G523.

Fee for Service Claim Submissions for E415A

  1. E415A is payable at 30% of the total fee approved amount of G521, G522 and G523 claims that are provided by the same physician, to the same patient, for the same service date.
  2. If an incoming claim is submitted for E415A without a paid G521-G523 service on the same claim or on history for the same patient, same service date, same physician, the incoming claim will pay at $0 with explanatory code 'DF-Corresponding fee code has not been claimed or was approved at zero'.
  3. If E415A is submitted with a service date prior to October 1, 2020, the claim will be rejected to the provider's error report with error code 'A3E-No such FSC'.
  4. A master number is required to be submitted with FSC E415A.
  5. If a claim is submitted for E415A without a master number, the claim will be rejected to the provider's error report with error code 'AH8-Invalid Admit Date/Hospital No'.

Keywords/Tags

E415A; G521; G522; G523; Critical Care; COVID-19, In-Hospital Protected or Pre-Emptive Protected Code Blue;

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