OHIP extends temporary payments for Selected Premiums and Management Fees

Ashley Lane
April 14, 2021

In order to provide patients access to health care through COVID and the roll-out of the vaccine, OHIP has extended temporary payments for selected premiums and management fees.

K083 Premiums

From March 14th, 2021 to September 30th, 2021 in-person K083 services are eligible for payment premiums. The total increments eligible for payment is equal to the fee listed in the Schedule of Benefits, plus the value of the applicable K083 Premium(s), rounded to the nearest $5, divided by 5. 

Examples Equivalent to Convert to K083
A neurologist (18) provides a virtual Medical Specific Assessment (equivalent to A183) to a patient with multiple sclerosis, which qualifies for a chronic disease assessment premium equivalent (calculated at rate of E078-add 50%) A183 = $79.80

E078 = $39.90

Total: $119.70

Round to $120

Divide this figure by 5

Claim K083 x 24 units

A pediatrician provides a consultation (A265)to a patient aged less than 30 days (age premium < 30 days-add 30%) A265 = $175.40

Age premium = $52.62

Total: $228.02

Round to $230

Divide this figure by 5

Claim K083 x 46 units

OHIP Premiums Eligible on K Codes

Eligible Premium Description Premium
Age-Based Fee Premiums Less than 30 days of age 30%
Age-Based Fee Premiums Between 30 days and one year of age 25%
Age-Based Fee Premiums Between one and two years of age 20%
Age-Based Fee Premiums Between two and five years of age 15%
Age-Based Fee Premiums Between five and 16 years of age 10%
Internal Medicine Office Assessment Premium   12%
E078 Chronic Disease Assessment Premium 50%
E060 Post renal transplant assessment premium 25%
K630 Psychiatric consultation extension $113.70
K187 Acute post-discharge community psychiatric care 15%
K188 High-risk community psychiatric care 15%
K189 Urgent community psychiatric follow-up $216.30

 

K082 Focused Practice Psychotherapy Premium

K082 claims submitted with diagnostic codes between 290-319 and 897-909 for mental health disorders are considered psychotherapy services and are eligible for 17% payment as of March 14th, 2021. Claims with service dates between March 14th, 2021 and September 30th, 2021 will be paid in Spring 2022.

*This premium excludes psychiatric or primary mental health care, counselling, or interviews.

Family Health Group (FHG) Physicians-10% Premium

As of March 14th, 2021 the temporary FHG 10% premium with virtual care codes K080, K081, and K082 services is extended until September 30th, 2021.

Management Fees for Telephone or Video Services

As of March 14th, 2021, codes K080, K081, K082, and K083 are included as a consultation or assessment until September 30th, 2021. You must perform an in-person physical exam to be eligible for payment. For more details, check out INFOBulletins 4764 and 201101.

 

Fee Code Description
K045 Endocrinology & Metab/Internal Med-Diabetes management by a specialist-annual
K046 Endocrinology & Metab/Internal Med-Diabetes team management-annual
K119 Pediatrics-pediatric developmental assessment incentive-annual
K481 Rheumatology-Rheumatoid arthritis management by a specialist-annual
Q040 GP/FP-Diabetes management incentive-annual
K682 Opioid Agonist Maintenance Program monthly management fee-intensive, per month
K683 Opioid Agonist Maintenance Program monthly management fee-maintenance, per month
K684 Opioid Agonist Maintenance Program-team premium, per month, to K682 or K683 add

Monthly Management of a Nursing Home or Home for the Aged

As of March 14th, 2021, patient care codes K080, K081, K082, and K083 provided by telephone or video are eligible for payment of the W010 (Monthly Management of a Nursing Home or Home for the Aged Patient) until September 30th, 2021.

Point of Care Drug Testing During COVID-19

Four point of care drug testing services G040, G041, G042, and G043 when using virtual care codes K080, K081, K082, and K083 are eligible for payment retroactively from March 14th, 2020 to March 13th, 2021. System changes necessary for payment processing start April 1st, 2021.

*You can claim fee codes G040A, G041A, G042A and G043A until June 30th, 2021.

After Hours Procedure Premiums During COVID-19

After-hours surgical and other elective in-hospital, IHF (Independent Health Facility), or non-hospital based surgical or other procedures provided after hours, on a weekend/holiday, or at night are eligible for premiums E409 and E410 until November 28th, 2021 (retroactive November 28th, 2020). For more details, check see INFOBulletin 201110

If you have any questions about these changes, reach out and we’ll be happy to help.

 


 

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