New OHIP Fee Codes in response to COVID-19 Pandemic

Courtney Marie L.
April 13, 2020

Updated: April 13th, 2020 (see new diagnostic code)

In an effort to limit the spread of COVID-19 in Ontario, the Minister of Health has released a temporary list of OHIP fee codes that cover assessments of, or counselling to, insured patients by telephone or video, or advice and information to a patient’s family member/legal representative by telephone or video, as well as a temporary sessional fee code.

While these codes came into effect March 14, 2020, OHIP is asking that none of the codes get submitted yet – so that they have time to set up the system changes in the next coming weeks. However, keep in mind that all COVID-19 OHIP fee codes can be backdated to March 14th, 2020 for payment.

Important Note for Dr. Bill users: You can submit the temporary fee codes through our software. We’ll hold them in our system until OHIP gives the okay to submit them – which we will then do automatically for you.

For more information on the changes please see the original message from OHIP.


COVID-19 Temporary OHIP Fee Codes

K080: Minor Assessment

Minor assessment of a patient by telephone or video, or advice or information by telephone or video to a patient’s representative regarding health maintenance, diagnosis, treatment and/or prognosis. $23.75.

K081: A. Intermediate assessment

Intermediate assessment of a patient by telephone or video, or advice or information by telephone or video to a patient’s representative regarding health maintenance, diagnosis, treatment and/or prognosis, if the service lasts a minimum of 10 minutes; or

B. Primary mental health care, counselling or interview (min. 10 minutes)

Psychotherapy, psychiatric or primary mental health care, counselling or interview conducted by telephone or video, if the service lasts a minimum of 10 minutes $36.85.

K082: Primary mental health care, counselling or interview (min. 30 minutes)

Psychotherapy, psychiatric or primary mental health care, counselling or interview conducted by telephone or video per unit (unit means half hour or major part thereof) per unit $67.75.

K083: Specialist consultation

Specialist consultation or visit by telephone or video payable in increments of $5.00.

*** K083 essentially allows you to bill all your usual fee code amounts for telephone or video assessments.

For Example: in Psychiatry, 1 unit of K198 psychiatric care, valued at $80.30 would be rounded down to $80, and then divided by 5, which is 16. That means you’d bill 16 units of K083.


IMPORTANT NOTE: It’s strongly recommended that all geriatricians move their clinics to a virtual setup as much as possible. Since frail seniors are at a greater risk, virtual care is a safer choice for patients.

In general, if your specialty allows it, you should start considering virtual care options for discussions with patients, as well as virtual options for your clinic or hospital department.


Rules and Regulations for COVID-19 temporary OHIP Fee Codes

1. Despite what it says in the Health Insurance Acts requirements of an insured service (i.e. a direct physical encounter must be made, and prescriptions over the phone aren’t covered) K080, K081 and K082 are eligible as long as:

  • The service was initiated by the patient or the patient’s representative;

  • The service is personally rendered by yourself.

2. K083 is only insured when:

  • The service was initiated by the patient or the patient’s representative;

  • The service is personally rendered by yourself;

  • Other than a direct physical encounter, all the conditions for the appropriate specialist consultation or visit as described in the Schedule of Benefits for Physician Services have been met.

3. Make sure you document what services you’ve provided on the patient’s medical record.

4. Must include start and stop times otherwise the claim will come back rejected.

5. K080, K081 K082, or K083 include the provision of a new prescription or prescription renewal if rendered.

6. K080, K081, K082, or K083 are not eligible for payment for anticoagulant supervision by telephone (G271) or any other telephone advice services listed in the Schedule of Benefits.

7. For the purpose of K083, the total increments eligible for payment is equal to the fee listed in the Schedule of Benefits for the appropriate service, rounded to the nearest $5, divided by 5.

8.  If K080, K081, K082 or K083 are claimed, you cannot receive any further payment from the patient or the patient’s representative for a telephone prescription resulting from the service.


COVID-19 Sessional Fee

H409 (assessment centre) per one hour period, or major part thereof $170.00.

“Eligible assessment centre” means a place designated by the Ministry of Health as eligible for COVID-19 sessional fees.

“COVID-19 sessional unit” means each one hour period, or major part thereof, on any day (including weekends or holidays).

Note: The amount payable for a COVID-19 sessional unit is for all insured services rendered during that hour and for being present in an eligible assessment centre and available to provide such insured services.

No other insured services are eligible for payment at an eligible assessment centre.


New Diagnostic Code for COVID-19 pandemic

OHIP has introduced a new diagonals code COVID-19.

This diagnostic code is effective as of March 14th and moving forward should be used when the primary purpose for the service is because your patient is suspected to have or has been diagnosed with COVID-19.

You can use it for all inpatients with COVID as well as any emergency patients.

New Diagonals Code: 080
Description:
Coronavirus


If you have any questions please contact OHIP’s support centre at 1-800-262-6524 or SSContactCentre.MOH@ontario.ca.

During this time, we’ll have extended support hours so if you have any questions or concerns don’t hesitate to get in touch.

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