Ontario Health Insurance Plan

INFOBulletin

COVID-19 Temporary Virtual Care Services

Temporary virtual care services are extended to September 30, 2021 and expanded to include palliative care fee codes


To: All Physicians
Category: Physician Services
Written by: Claims Services Branch, Ontario Health Insurance Plan Division
Date issued: April 9, 2021
Bulletin Number: 210403


Table of Contents

Temporary Physician Funding Related to COVID-19
Services by Phone or Video
Services by Phone or Video-Palliative Care
Palliative Care Fee Code Descriptions
This bulletin is a general summary
The Schedule of Benefits for Physician Services
Keywords/Tags
Contact Information


Temporary Physician Funding Related to COVID-19

The Ministry of Health (ministry) continues to support the government’s efforts to stop the spread of COVID-19 in Ontario. In accordance with an agreement between the ministry and the Ontario Medical Association (OMA), existing temporary physician funding initiatives under the Ontario Health Insurance Plan (OHIP) are being extended and enhanced. This will ensure patients continue to have access to the health care they need through the pandemic and the roll out of the COVID-19 vaccine. These initiatives were announced in INFOBulletin 210304, and include:

  • Extending the COVID-19 temporary OHIP virtual care fee codes (K080, K081, K082, and K083) for physician phone and video visits until September 30, 2021. Please refer to INFOBulletin 4745 for more details on this initiative.
  • Four new COVID-19 temporary OHIP virtual care fee codes specific for palliative care services (K092, K093, K094, and K095). These are eligible for payment for services provided in the period between March 14, 2021 and September 30, 2021.

The Schedule of Benefits for Physicians Services (Schedule) is being amended effective March 14, 2021 to reflect these changes.

Services by Phone or Video

Effective March 14, 2021 the Schedule has been amended to extend the inclusion of assessments of or counselling to insured persons by telephone or video, or advice and information to patient representatives by telephone or video as OHIP-insured services until September 30, 2021. These four fee codes are set out in the table below:

Fee Schedule Code Description Value
K080 Minor assessment of a patient by telephone or video, or advice or information by telephone or video to a patient's representative regarding health maintenance, diagnosis, treatment and/or prognosis. $23.75
K081
  1. Intermediate assessment of a patient by telephone or video, or advice or information by telephone or video to a patient's representative regarding health maintenance, diagnosis, treatment and/or prognosis, if the service lasts a minimum of 10 minutes; or
  2. Psychotherapy, psychiatric or primary mental health care, counselling or interview conducted by telephone or video, if the service lasts a minimum of 10 minutes
$36.85
K082 Psychotherapy, psychiatric or primary mental health care, counselling or interview conducted by telephone or video per unit (unit means half hour or major part thereof) per unit $67.75
K083 Specialist consultation or visit by telephone or video payable in increments of $5.00 per increment

Services by Phone or Video-Palliative Care

Effective March 14, 2021 the Schedule has been amended to temporarily list as insured services virtual palliative care consultation (by telephone and by video), and virtual palliative care support (by telephone and by video). These four new fee codes are set out in the table below:

Fee Schedule Code Description Value
K092 Virtual Palliative Care Consultation-Telephone $159.20
K093 Virtual Palliative Care Consultation-Video $159.20
K094 Virtual Palliative Care Support-Telephone $72.15
K095 Virtual Palliative Care Support-Video $72.15

The new fee codes will be effective for services provided between March 14, 2021 and September 30, 2021. While payment for the provision of services associated with these temporary codes is effective March 14, 2021, system changes required to process payment are planned for May 2021. As a result, the ministry requests that physicians wait to submit claims for these codes until further notice. A further INFOBulletin will follow once these codes are eligible to be submitted.

Palliative Care Fee Code Descriptions

K092 and K093 are considered special palliative care consultations that are requested because of the need for specialized management for palliative care where the physician spends a minimum of 50 minutes with the patient and/or patient's representative/family in consultation by video or telephone (the majority of time must be spent in consultation with the patient). In addition to the general requirements for a consultation, the service includes a psychosocial assessment, comprehensive review of pharmacotherapy, appropriate counselling and consideration of appropriate community services, where indicated.

K094 and K095 are considered palliative care support fee codes. These are time-based services payable for providing pain and symptom management, emotional support and counselling to patients receiving palliative care (by video or telephone). They are payable in increments of ½ hour (or major part thereof).

An additional INFOBulletin with more detail will be released by the ministry when these fee codes are eligible to be submitted.

This bulletin is a general summary

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 current legislation and regulation 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.

The Schedule of Benefits for Physician Services

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.

Keywords/Tags

OHIP; Physicians; COVID-19; Palliative; Virtual; Telephone; Video

Contact Information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.

Find INFOBulletins online on the Ministry of Health website.

For More Information

Call ServiceOntario, Infoline at:
1–866–532–3161 (Toll–free)
In Toronto, (416) 314–5518
TTY 1–800–387–5559.
In Toronto, TTY (416)327–4282
Hours of operation: Monday to Friday, 8:30am – 5:00pm

 
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