The April 1, 2023 changes to the OHIP Schedule of Benefits are important for health care professionals as these updates will affect some physicians’ billing habits and claim payments. To save physicians time, we’ve summarized the key changes from 25 recent ministry INFOBulletins into a single quick-reference guide below.
The following chart details:
- Pertinent deadlines
- New, delisted, & amended fee codes
- Which physicians, groups and patients are affected
- Key highlights from each INFOBulletin
If you are a Dr.Bill client, please rest assured that our billing software has been updated with these changes and your billing will continue uninterrupted.
Dr.Bill’s searchable OHIP Billing Code Database has also been updated--a complimentary resource for all physicians that makes it easy to search the updated Schedule of Benefits electronically.
If you have any questions about the recent Ministry changes, don’t hesitate to contact us.
| Service dates affected: Apr 1, 2023, onward | |||
| Bulletin # | Who is affected | Change | Timelines and Details |
| 230305 | Physician & Hospital Services for Uninsured Patients (PHSUP) | PHSUP funding ends | - Services provided April 1, 2023, onward, will not be eligible for payment via PHSUP. - Hospitals have 12 months from the date of service to submit PHSUP billings for service dates up to, and including March 31, 2023 |
| 230305 | All Physicians | Discontinued: Virtual codes K087-K089 | - Physicians have 6 months from the date of service to submit K087, K088, & K089 billings for service dates up to, and incl., March 31, 2023 - Services provided April 1, 2023, onward, will not be eligible for payment |
| 230305 | All Physicians | Manual payments end: COVID-19 vaccination for uninsured persons (fee codes G593, Q593 & Q007) | - G593, Q593 & Q007, billed 01Apr2023 onward, will not be eligible for payment. - Manual payments for G593, Q593 & Q007 end 31Mar2023 |
| 230309 | All Physicians | Aerosol-Generating Medical Procedures (AGMP) Modifier Payments (E404 & E405) & Life Threatening Critical Care Premiums (E415) end 31Mar2023 | - Physicians have 6 months from the date of service to submit billings of E404, E405, & E415 for services up to, and incl., 31Mar2023 - E404, E405, or E415 for service dates of 01Apr2023, onward, will be rejected to the providers' Error report (A3E 'No such service code for date of service’) |
| 230310 | All Physicians & Hospitals | 2.01% global increase to physician payments (services rendered between 01Apr2022 and 31Mar2023) replaced by permanent fee code adjustments | Service dates affected: 01Apr2022-31Mar2023 New Schedule of Benefits (effective 01Apr2023) includes fee increases accounting for 2.01% global increase. |
| 230310 | All Physicians & Hospitals | OHIP specialty designations in Critical Care Medicine (11) added to SoB | New billing codes applicable for Critical Care Medicine (11) specialists from 01Apr2023 onward. SoB pages A90 & A91. |
| 230310 | All Physicians & Hospitals | Various fee codes introduced, delisted, and revised in the Schedule of Benefits | - Effective for certain services provided on service dates 01Apr2023, onward: - New fee codes - Fee codes delisted - Revised fee - Fee value changes |
| 230310 | All Physicians & Hospitals | All technical services will continue to pay at 2.01% increased rate (except technical services performed in hospital) | - Technical services provided 01Apr2023, onward, will continue to pay at the 2.01% increased rate applied April 1, 2022, except for technical services performed in hospital |
| 230310 | All Physicians & Hospitals | Unit fee increases effective April 1, 2023 | - Assistant Unit Fee increased to $12.51 - Anaesthesiologist Unit Fee increased to $15.49 |
| 230312 | All Physicians | Year 3 Increases - Contract Management Unit | - Temporary Year 1 and Year 2 increases to the following programs will be replaced as outlined: - Emergency Department Clinical Decision Unit: 2.0524% - Psychiatric Stipend: 3.0540% - Hospital Paediatric Stabilization: 2.4107% - Hospital On-Call (HOCC): 2.0100% - Community Palliative Care On-Call (CPOC): 2.0100% - Physicians On-Call (POC): 2.0100% - Complex Continuing Care (CCC): 2.0100% - Ontario Fertility Program (Physician service portion): 2.0100% **The above increases will be achieved through amendments to the contracts |
| 230313 | Family Health Network (FHN) Physicians, Family Health Organization (FHO) Physicians | Year 3 Increases - Family Health Network and Family Health Organization | - Blended Fee-For Services (BFFS) premium payments increased from 15% to 19.41% - Fee-For-Service billing limits for core services provided to non-enrolled patients (the Hard Cap) increased by 1.7817% - Codes introduced and added to the “basket” of fee codes:K133A -’Periodic Health Visit for Adults with Intellectual and Developmental Disabilities’ is eligible for the after-hours premium when billed with a Q012A for enrolled patients - G552-Removal of intrauterine contraceptive device (IUD)’ |
| 230314 | Comprehensive Care Model (CCM) Physicians, Family Health Group (FHG) Physicians | Year 3 Increases - Family Health Group and Comprehensive Care Model | K133A ’Periodic Health Visit for Adults with Intellectual and Developmental Disabilities’ introduced, and is eligible for the: - 10% comprehensive care premium when claimed by an FHG signatory or locum provider for an enrolled or assigned patient of a physician in the FHG on the service date - after-hours premium when billed with a Q012A (FHG) or Q016A (CCM) for enrolled patients. |
| 230315 | All Physicians | Year 3 Increases - Special Premiums | Palliative Care Special Premium bonus increased by 20%. Two threshold levels: - Level 1 - all eligible physicians, incl. Patient Enrolment Models (PEMs) - Level 3 -PEM eligible physicians only Long-Term Care Special Premium bonus increased by 20%. Two threshold levels: - Level 1 - all eligible physicians, incl. Patient Enrolment Models (PEMs) - Level 3 -PEM eligible physicians only Primary Care Serious Mental Illness (PC-SMI) Special Premium bonus increased by 20%. Two threshold levels - Only PEM physicians (except Comprehensive Care Model (CCM) physicians) eligible for this premium; and only claims for patients enrolled to the billing physician are eligible **See Bulletin outlining specific criteria for thresholds - New service G552 ‘Removal of intrauterine contraceptive device’ added to the list of services eligible towards the Office Procedures category |
| 230316 | Aboriginal Family Health Team (AFHT) Physicians | Year 3 Increases - Aboriginal Family Health Team | - Blended Fee-for-Service (BFFS) premium payments increased from 5% to 20% - Base & Benefit payments increased by 2.5% (will be reflected on the May 2023 Remittance Advice) |
| 230317 | Blended Salary Model (BSM) Physicians | Year 3 Increases - Blended Salary Model | - Blended Fee-for-Service (BFFS) premium payments increased from 5% to 15%Base, Benefit, & Locum payments increased by 2% (will be reflected on the May 2023 Remittance Advice) - Fee-For-Service billing limits for core services provided to non-enrolled patients (the Hard Cap) increased by 2.6186% - Certain H-prefix fee codes deleted (see Bulletin for details) K133A-Periodic Health Visit for Adults with Intellectual and Developmental Disabilities’ is eligible for the after-hours premium when billed with a Q012A for enrolled patients |
| 230318 | Community Health Centre (CHC) Physicians | Year 3 Increase - Community Health Centre | - Base salary, benefits & relief payments for all CHC physicians increased by 2.5% **Amendments to funding agreements to account for increase will be finalized ASAP (Payments will be retroactive to 01Apr2023) |
| 230319 | Family Health Team Specialist Sessional Group (FHTSSG) Physicians | Year 3 Increase - Family Health Team Sessional Group | - Sessional fee payments under funding agreements increased by 3.0540% **Amendments to funding agreements to account for increase will be finalized ASAP (Payments will be retroactive to 01Apr2023) |
| 230320 | Indigenous Primary Health Care Organization (IPHCO) Physicians | Year 3 Increase - Indigenous Primary Health Care Organization | - Base & Benefit payments under funding agreements increased by 2.5% **Amendments to funding agreements to account for increase will be finalized ASAP (Payments will be retroactive to 01Apr2023) |
| 230321 | Nurse Practitioner (NP) Physician Collaboration Programs | Year 3 Increase - Nurse Practitioner-Physician Collaboration Programs | - Nurse Practitioner Led Clinics (NPLC) & Primary Care Nurse Practitioner Program (PCNP) Monthly Consultation Fee under funding agreements increased by 3.3385% **Amendments to funding agreements to account for increase will be finalized ASAP |
| 230322 | Group Health Centre (GHC) Physicians | Year 3 Increase - Group Health Centre | - Blended Fee-For-Service (BFFS) premium payments increased from 10% to 15% - Fee-For-Service billing limits for core services provided to non-enrolled patients (the Hard Cap) increased by 2.6186% - Fee increases & new fee codes introduced - Fee codes deleted - K133A-Periodic Health Visit for Adults with Intellectual and Developmental Disabilities’ eligible for the after-hours premium when billed with a Q012A for enrolled patients - Base salary amounts for Fera Medical Professional Corporation physician specialists increased by the approved percentage for each specialty classification (increased payments will be reflected in Monthly Transfer Payment ASAP) |
| 230323 | Rural and Northern Physician Group Agreement (RNPGA) Physicians-Groups 1 & 2 | Year 3 Increase - Rural and Northern Physician Group Agreement | - Blended Fee-For-Service (BFFS) premium payments increased from 5% to 9.65% - K133A-’Periodic Health Visit for Adults with Intellectual and Developmental Disabilities’ eligible for the after-hours premium when billed with a Q012A for enrolled patients - G552-Removal of intrauterine contraceptive device (IUD)’ will pay Fee-For-Service (FFS) when billed with a Q022A where eligibleCertain services when billed with a ‘B-Suffix’ or ‘C-Suffix’ will pay FFS when billed with Q022A where eligible |
| 230324 | Sioux Lookout Regional Physician Services Incorporated (SLRPSI) Physicians | Year 3 Increase - Sioux Lookout Regional Physician Services Incorporated | - Blended Fee-For-Service (BFFS) premium payments increased from 5% to 20% - Payment of codes Q500-Q509 under funding agreement will be increased by 11% (will be reflected on May 2023 Payment Summary) |
| 230325 | Underserviced Area Program (UAP) Physicians | Year 3 Increase - Underserviced Area Programs | The below payment elements in funding agreements will be increased as outlined: - Northern Physician Retention Initiative: 2.6625% - Northern Rural Recruitment Retention Initiative: 2.1599% - Nursing Station Physician Outreach - Honorarium per day: 3.3385% - Nursing Station Physician Outreach - Stipend per day: 3.3385% - Nursing Station Physician Outreach - Telephone Back-up per Month: 3.3385% - Ontario Psychiatric Outreach Program - Honorarium: 3.0540% - Ontario Psychiatric Outreach Program - Travel Sessional: 3.0540% - Ontario Psychiatric Outreach Program -Sessional: 3.0540% - Visiting Specialist Clinic Program - Honorarium: 3.0540% - Visiting Specialist Clinic Program - Travel Sessional: 3.0540% Visiting Specialist Clinic Program - Sessional: 3.0540% **Amendments to funding agreements to account for increase will be finalized ASAP (Payments will be retroactive to 01Apr2023) |
| 230326 | Weeneebayko Area Health Authority (WAHA) Physicians | Year 3 Increase - Weeneebayko Area Health Authority | - Blended Fee-For-Service (BFFS) premium payments increased from 5% to 20% - Base payments under funding agreement increased by 0.875% (will be reflected on May 2023 Payment Summary) - K133A-’Periodic Health Visit for Adults with Intellectual and Developmental Disabilities’ eligible for the after-hours premium when billed with a Q012A for enrolled patients |
| 230327 | General Practitioner Focused Practice-Care of the Elderly (GPFP-COE) Physicians | Year 3 Increase - GP Focused Practice-Care of the Elderly | - Blended Fee-For-Service (BFFS) premium payments increased from 5% to 20% - Base payments under funding agreement increased by 8.25% (will be reflected on May 2023 Payment Summary) - Fee-For-Service billing limits for core services provided to non-enrolled patients increased by 3.3385% - After-Hours Threshold increased by 3.3385% - Some H-prefix codes deleted - K133A-’Periodic Health Visit for Adults with Intellectual and Developmental Disabilities’ eligible for the after-hours premium when billed with a Q012A for enrolled patients |
| 230328 | General Practitioner Focused Practice-HIV (GPFP-HIV) Physicians | Year 3 Increase - GP Focused Practice-HIV | - Blended Fee-For-Service (BFFS) premium payments increased from 5% to 20%Base payments under funding agreement increased by 11% (will be reflected on May 2023 Payment Summary) - Fee-For-Service billing limits for core services provided to non-enrolled patients increased by 3.3385% - After-Hours Threshold increased by 3.3385% - Some H-prefix codes deleted - K133A ’Periodic Health Visit for Adults with Intellectual and Developmental Disabilities’ eligible for the after-hours premium when billed with a Q012A for enrolled patients |
| 230329 | General Practitioner Focused Practice-Palliative Care (GPFP-PC) Physicians | Year 3 Increase - GP Focused Practice-Palliative Care | - Blended Fee-For-Service (BFFS) premium payments increased from 5% to 20% - Base payments under funding agreement increased by 16% (will be reflected on May 2023 Payment Summary) - Fee-For-Service billing limits for core services provided to non-enrolled patients increased by 3.3385% - After-Hours Threshold increased by 3.3385% |
| 230330 | Homeless Shelter Agreement (HSA) Physicians | Year 3 Increase - Homeless Shelter Agreements | - Blended Fee-For-Service (BFFS) premium payments increased from 10% to 20% - Payment elements for codes Q301A-Q305A increased by 33.5% for service dates on or after April 1, 2023 (will be reflected on May 2023 Payment Summary) - Base Sessional & Medical Director Thresholds increased by 33.5% - Blended Fee-For-Service Thresholds for Inner City Health Associates (ICHA) & Shelter Health Network (SHN) increased by 100% - After-Hours Threshold for Sherbourne Physicians Group (SPG) increased by 33.5% |
| 230331 | St. Joseph’s Health Centre (SJHC) Physicians | Year 3 Increase - St. Joseph’s Health Centre | - Blended Fee-For-Service (BFFS) premium payments increased from 10% to 15% - Base payments under funding agreement increased by 31% (will be reflected on May 2023 Payment Summary) - Fee-For-Service billing limits for core services provided to non-enrolled patients increased by 2.6186% - New fee schedule codes introduced & some fee codes deleted - K133A ’Periodic Health Visit for Adults with Intellectual and Developmental Disabilities’ eligible for the after-hours premium when billed with a Q012A for enrolled patients |
| 230332 | Toronto Palliative Care Associates (TPCA) Physicians | Year 3 Increase - Toronto Palliative Care Associates | - Blended Fee-For-Service (BFFS) premium payments increased from 5% to 20% - Base payments under funding agreement increased by 11.4% (will be reflected on May 2023 Payment Summary) - Fee-For-Service billing limits for core services provided to non-enrolled patients increased by 3.3385% - After-Hours Threshold increased by 3.3385% |
| Service dates affected: Jul 1, 2023, onward | |||
| 230308 | All Physicians | COVID-19 Sessional Fees (H409, H410) & After Hours Procedure Premiums (E409 & E410) expire on June 30, 2023 | To submit billings for H409/H410 and E409/E410 physicians have: - 6 months from the date of service for service dates up to, and incl., 31Mar2023 - 3 months from the date of service for service dates 01April2023 to, and incl., 30Jun2023 |
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