Ontario Health Insurance Plan

INFOBulletin

Update: Temporary COVID-19 Vaccine Fee Codes

Recent system changes allows physicians to bill temporary COVID-19 vaccine related fee codes G593, Q593 and Q007.


To: Physicians, Primary Care Physicians
Category: Physician Services, Primary Health Care Services
Written by: Negotiations Branch, Ontario Health Insurance Plan Division
Date issued: June 8, 2021
Bulletin Number: 210601


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.

Physicians can now bill the G593 immunization code for services rendered on or after March 6, 2021.

Temporary Fee Code (G593)

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".

Please note that expired health cards may continue to be used for accessing insured health services and providers are encouraged to follow existing health card validation services to determine health card validity. For more information on expired and expiring health cards during COVID-19, please see INFOBulletin 201107.

Uninsured Patients/Invalid Health Cards

Where an uninsured patient (e.g. international students, out of province patient) or a patient with an invalid health card receives a COVID-19 vaccine in a primary care setting, the physician will be required to contact the Ministry to claim the service. Supporting information including identification of the physician and patient surname, first name, date of birth and address information will be required. If applicable, a manual payment will be issued congruent with the relevant fee schedule codes associated with COVID-19 vaccine administration for insured services. Physicians should contact the ministry through the Service Support Contact Centre by email or at 1-800-262-6524.

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. Primary care physicians can now bill the Q593 sole visit premium for services rendered on or after March 6, 2021.

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 patient’s 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 Centre
  • Rural and Northern Physician Group Agreements
  • Weeneebayko Area Health Authority
  • Saint Joseph's Health Centre
  • Toronto Palliative Care Agreements
  • General Practitioner Palliative Care
  • General Practitioner Focus Care of the Elderly
  • General Practitioner Focus HIV
  • Homeless Shelter Agreements
  • Sioux Lookout Agreements
  • Community Sponsored Agreement/Blended Salary Model
  • New Graduate Entry Program
  • Income Stabilization
  • Aboriginal Family Health Team
  • Family Health Team Specialists Physicians

Primary care providers working in Assessment Centres 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 Centre.

Family Health Group (FHG) and Comprehensive Care Model (CCM) 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%).

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 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: Physicians can now submit this temporary fee code for services rendered on or after March 6, 2021 and the ministry will make a one time lump sum payment at a later date. Further information will be forthcoming regarding when payment will be made.

Keywords/Tags

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

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