A Comprehensive Guide to OHIP Billing Codes for Virtual Care and COVID-19

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.

  1. OHIP Virtual Care Billing Codes
  2. COVID-19 Diagnostic Codes
  3. COVID-19 Vaccine Fee Codes
  4. 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:

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
Payable for the administration of each dose of vaccine when multiple doses are required to complete the initial vaccination series.

$13

Q593

Sole visit premium COVID-19 PEM
Eligible for payment with the G593 “COVID-19 vaccine” when delivery of COVID-19 vaccination is the sole reason for the patients visit.  

$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!

 

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