During the wake of the COVID-19 pandemic, the Ministry of Health implemented significant changes to how physicians are compensated. We have seen that the volume and frequency of changes has been hard on physicians to manage their day-to-day billings and clinic operations. In this blog, we summarize the latest updates on virtual care and COVID-19 and share some tips on how to best bill those fee codes to ensure you are getting paid for the care you are providing.
- OHIP Virtual Care Billing Codes
- COVID-19 Diagnostic Codes
- COVID-19 Vaccine Fee Codes
- COVID-19 Premiums
1. OHIP Virtual Care Billing Codes
The Ministry introduced the new virtual care funding framework effective December 1, 2022. This new framework requires physicians to bill the fee codes under comprehensive virtual care services and limited care services.
Comprehensive Virtual Care Services
The Comprehensive Virtual Care Services are billed for patients who have an existing/ongoing physician-patient relationship. This means that the patient is enrolled to the provider or with another provider within the same group, or the patient was seen on an in-person visit in the preceding 24 months.
Modality Indicator Codes
The modality indicator codes K300/K301 are added to patient visit fee codes when the service is provided virtually:
Fee Code |
Description |
Payable Amount |
K300 |
Identifies video technology used during service |
100% of the fee amount |
K301 |
Identifies telephone technology used during service |
85% of fee amount |
Limited Virtual Care Services
The Limited Virtual Care visit codes are billed for patients who are not enrolled and have not been seen in person in the preceding 24 months. These codes are in-basket and are not eligible to be billed with Q012.
Fee Code |
Description |
Value |
A101 |
Limited Virtual Care by Video |
$20 |
A102 |
Limited Virtual Care by Telephone |
$15 |
Note: For FHO/FHN physicians, they will be paid at the shadow billing rate for rostered patients, and full fee-for-service rate for non-rostered patients.
Some tips:
- Existing schedule requirements will apply to all virtual care services.
- Virtual care services are not eligible for payment where it is not medically appropriate to provide the services without a direct physical encounter.
- Video services must be performed using a verified virtual visit solution (https://www.ontariohealth.ca/system-planning/digital-standards/virtual-visits-verification/verified-solutions-list).
- The physician and patient must be located in Ontario during the visit.
For detailed information on how to bill for virtual care, download our quick reference guide here.
2. COVID-19 Diagnostic Code
The diagnostic code “080 – Coronavirus” can be used when the primary purpose for the service is treating patients with a suspected or confirmed case of COVID-19 whether in patient, by telephone, or video. This code can be used for all inpatients with COVID-19 as well as any emergency patients.
3. COVID-19 Vaccine Fee Codes
For administering the COVID-19 vaccine, there are two specific codes that you can bill:
Fee code |
Description |
Value |
G593 |
COVID-19 vaccine |
$13 |
Q593 |
Sole visit premium COVID-19 PEM |
$5.60 |
Notes:
- G593 is not eligible for payment for subsequent booster COVID-19 vaccination doses.
- G593 is not eligible for the FHG Comprehensive Care Premium (10%).
- G593 and Q593 are out of basket in all primary care patient enrolment models.
We have created a quick reference guide for the COVID-19 vaccine fee codes. You can download it here.
4. COVID-19 Premiums
After Hours Procedure Premiums (Valid until March 31st, 2024)
In response to the backlog of surgeries and other procedures that have been delayed due to COVID-19, the MOH has implemented a temporary revision of the current payment criteria for physicians to receive a premium when performing after-hours surgeries or other procedures listed in the Schedule of Benefits.
Physician – other than an Emergency Department Physician
Fee Code |
Description |
E409 |
Evenings (17:00h-24:00h) Monday to Friday or daytime and Evenings on Saturdays, Sundays, Holidays-increase the procedural fee(s) by 50%. |
E410 |
Nights (00:00h-07:00h)-increase the procedural fee(s) by 75%. |
Emergency Department Physician
Fee Code |
Description |
E412 |
Evenings (17:00h-24:00h) Monday to Friday or daytime and evenings on Saturdays, Sundays, Holidays-increase the procedural fee(s) by 20%. |
E413 |
Nights (00:00h-07:00h)-increase the procedural fee(s) by 40%. |
Notes:
- E409/E410 is not payable for a procedure rendered by an Emergency Department Physician.
- E412/E413 is only payable for a procedure rendered by an Emergency Department Physician who at the time the service was rendered is required to submit claims using “H” prefix emergency services.
We have created a quick reference guide for the After-Hours Procedure Premiums. You can download it here.
The on-going changes in billing codes can be confusing, resulting in missed billing opportunities and errors for physicians. DoctorCare continues to monitor changes and guidance from federal, provincial and municipal public health authorities to help you stay up to date on the latest updates. To learn more about how we can help, contact us today!