Ontario Health Insurance Plan

INFOBulletin

New Virtual Care Funding Framework-Updated Schedule of Benefits

The Schedule of Benefits has been updated to reflect the new virtual care funding framework (effective December 1, 2022)


To: All Physicians
Category: Physician Services
Written by: Provider Services Branch; OHIP, Pharmaceuticals and Devices Division
Date issued: October 21, 2022
Bulletin Number: 221002


New Virtual Care Funding Framework

The Ministry of Health (the Ministry) is making changes to the Schedule of Benefits for Physician Services (Schedule) to implement the new virtual care funding framework set out in the 2021 Physician Services Agreement (PSA).

The new version of the Schedule is now available on the Ministry’s website, however, please note that changes with respect to virtual care will not take effect until December 1, 2022, for service dates on or after December 1, 2022.

A new section has been added under Consultations and Visits titled “Virtual Care Services” which begins on page A64. All information with respect to the new virtual care funding framework is contained within this section of the Schedule, as well as the new “Appendix J”.

As per INFOBulletin #220901-Implementation of the new Virtual Care Funding Framework, the temporary virtual care K-Codes (K080, K081, K082, K083, K092, K093, K094, K095) will remain in place until November 30, 2022. Additionally, effective December 1, 2022, video visits delivered through the Ontario Virtual Care Program (OVCP) will be transitioned into the OHIP insured framework in accordance with the pricing structure, rates and payment parameters outlined in the PSA.

An additional INFOBulletin will follow with information on claim submission instructions for the new virtual care funding framework.

Resources

The joint Ministry-OMA Education and Prevention Committee (EPC) will be releasing EPC Billing Briefs specific to the new virtual care funding framework. These will be posted shortly on the OHIP Resources for Physicians webpage. EPC Billing Briefs provide general advice and guidance to physicians on specific billing matters and are for education and informational purposes only. The new EPC Billing Briefs for virtual care are intended to assist physicians in familiarizing themselves with the parameters of the new virtual care funding framework. Please sign up for OHIP Announcements to receive notice of new EPC Billing Briefs as well as other information from the Ministry.

Additionally, the College of Physicians and Surgeons of Ontario has issued professional standards and guidance with respect to virtual care.

Keywords/Tags

OHIP; Physicians; COVID-19; Virtual; Virtual care; K-Codes; Ontario Virtual Care Program; OVCP; Video; Phone; Physician Services Agreement.

Contact Information

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

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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