Bulletin 201108 — Temporary Fees for Identified AGMPs in Community Settings
Physicians are now eligible to receive a temporary modifier OHIP payment for eligible AGMPs performed outside of hospitals.
To: Physicians
Category: Physician Services
Written by: Health Services Branch, Ontario Health Insurance Plan Divisio
Date issued: November 26, 2020
To further support the government’s efforts in responding to the COVID-19 outbreak in Ontario, the Ministry of Health (ministry) and the Ontario Medical Association (OMA) have reached an agreement to implement a temporary 30% modifier payment for eligible Aerosol-Generating Medical Procedures (AGMPs) performed outside of hospitals.
Temporary Modifier Payment for Community Based AGMPs
The new temporary modifier payment will be applicable to eligible AGMPs rendered in community settings on or between October 1, 2020 and March 31, 2021 and under the eligibility criteria noted below, unless the ministry and the OMA agree to further extensions.
The list of eligible AGMPs in community settings will mirror the list used for the equivalent modifier payment for AGMPs performed in hospitals, which was implemented as part of the larger COVID-19 temporary payments implemented for physician services in-hospital (please refer to INFOBulletin 4758 titled “Temporary Fees for Identified AGMP Procedures-COVID-19-Hospital Physician Compensation” for additional information). This list of eligible AGMPs is currently being expanded to include additional procedures.
All eligible AGMPs, including the current list of eligible AGMPs and additional procedures to be added by the ministry, are listed in Appendix A.
Note: The new temporary modifier for community-based AGMPs will only be eligible for payment on AGMPs when the AGMP:
- Is rendered to patients who are COVID-19 positive, or at risk of being COVID-19 positive; and
- Commences between the hours of 7 am and 5 pm on weekdays.
Patients defined as at risk of being COVID-19 positive in community settings include those who:
- Screen positive for COVID-19 based on the current Public Health Ontario (PHO) screening guidance; or
- Live in or have recently travelled to public health unit regions defined by PHO as level Orange-Restrict or higher, as defined in the COVID-19 Response Framework: Keeping Ontario Safe and Open.
While payment for the provision of services associated with the new temporary modifier payment for community-based AGMPs is effective October 1, 2020, system changes are required in order to expand the list of eligible AGMPs and process payments for these services.
Physicians will need to wait to submit claims for these payments until further notification from the ministry, which will be communicated through a future INFOBulletin.
By claiming and accepting the temporary modifier payments, physicians will be deemed to agree to the following terms and conditions:
- All payment requirements in the Schedule of Benefits for Physician Services that are applicable to the eligible AGMPs must also be met for these temporary modifier payments to be payable.
- The same claims submission requirements for insured services in Regulation 552 under the Health Insurance Act must also be met when submitting claims for the temporary modifier payment described above.
Appendix A-Eligible AGMPs
Current List of Eligible AGMPs
| Fee Schedule Code | Descriptor | April 2020 Price |
|---|---|---|
| Anaesthesia | Anaesthesia unit fee | $15.29 |
| E600 | Larynx-Endoscopy- Laryngoscopy- Using operating microscope-To charges for laryngoscopy add | $33.60 |
| G050 | Trachea and Bronchi-Endoscopy-Bronchoscopy-Endobronchial ultrasound (EBUS), for guided biopsy of hilar and/or mediastinal lymph nodes |
$203.05 |
| G579 | Echocardiography-Transoesophageal echocardiography-Saline study (including venipuncture, to G571, G574, G581 or G584 add | $11.35 |
| G580 | Echocardiography-Transoesophageal echocardiography-Insertion of oesophageal transducer | $45.00 |
| G581 | Echocardiography-Transoesophageal echocardiography-professional component (P1) | $25.00 |
| M012 | Nose-Reconstruction-Septoplasty | $293.95 |
| M054 | Accessory Nasal Sinuses-Endoscopic approach-Intranasal maxillary antrostomy -unilateral -by endoscopic or endonasal approach | $123.70 |
| M055 | Accessory Nasal Sinuses-External or Endonasal Approach-Maxillary-Caldwell- Luc (includes intranasal antrostomy)-Unilateral | $247.35 |
| M056 | Accessory Nasal Sinuses-Maxillectomy-Partial or complete | $971.75 |
| M061 | Accessory Nasal Sinuses-External or Endonasal Approach-Sphenoid-Trans-Septal sphenoidectomy for tumour or radical exenteration of disease | $355.65 |
| M081 | Larynx-Excision-Laryngectomy-Total | $838.90 |
| M083 | Accessory Nasal Sinuses-Ethmoidectomy/antrostomy-Intranasal ethmoidectomy including maxillary antrostomy, with endoscope -unilateral (not eligible for payment with M061 or M054) | $350.00 |
| M084 | Larynx-Excision-Laryngectomy-Segmental, including reconstruction | $888.85 |
| M086 | Accessory Nasal Sinuses-Ethmoidectomy/antrostomy-Transnasal endoscopic repair of CSF rhinorrhea (includes harvesting of graft material) with or without 3D CT/MRI image guided system | $822.45 |
| M105 | Chest Wall and Mediastinum-Excision-Chest wall tumour, resection of 2 or 3 ribs or cartilages | $650.00 |
| M135 | Lungs and Pleura-Incision-Major decortication of lung for empyema or tumour | $848.80 |
| M137 | Respiratory /Cardiovascular Surgical Procedures-Lungs and pleura-Incision-Multi-Thoracotomy with or without biopsy | $390.65 |
| M142 | Lungs and Pleura-Excision-Pneumonectomy, may include radical mediastinal node dissection, sampling or pericardial resection requiring repair | $1,485.40 |
| M143 | Lungs and Pleura-Excision-Lobectomy, may include radical mediastinal node dissection or sampling | $1,402.60 |
| M145 | Lungs and Pleura-Excision-Wedge resection of lung | $843.40 |
| M149 | Lungs and Pleura-Excision-Pleurectomy, and/or apical bullectomy for pneumothorax | $525.00 |
| M151 | Lungs and Pleura-Excision-Bullectomy for major bullous disease | $725.00 |
| N111 | Cranial-Skull Base Surgery-Resection of lesion(s)-Endonasal Approach-Pituitary lesion(s)-Transsphenoidal microscopic resection of lesion(s) originating in the sella turcica requiring simple closure, repair and/or reconstruction of surgical defect(s) | $1,879.00 |
| N112 | Cranial-Brain-Skull Base Surgery -Surgical Access-Endonasal Approach-Surgeon not rendering resection of lesion(s)-Endonasal endoscopic or microscopic approach for surgical access to sella turcica-Includes when rendered middle turbinate reductions, maxillary antrostomies, ethmoidotomies, ethmoidectomies, sphenoidotomies, septotomy, septoplasty and septal mucosal flap(s) harvest associated with septotomy or sphenoidal mucosal flap(s) | $1,360.00 |
| N114 | Cranial-Skull Base Surgery-Resection of lesion(s)-Endonasal Approach-Pituitary lesion(s)-Transsphenoidal endonasal endoscopic resection of lesion(s) originating in the sella turcica requiring simple closure, repair and/or reconstruction of surgical defect(s) | $1,742.45 |
| N116 | Cranial-Skull Base Surgery-Resection of lesion(s)-Endonasal Approach-Non- Pituitary lesion(s)-Endonasal endoscopic resection of non- Pituitary lesion(s) not originating from pituitary tissue requiring simple closure, repair and/or reconstruction of surgical defect(s) | $2,243.45 |
| N150 | Cranial-Cerebral Injury-C.S.F. leak-Intracranial repair (to include trans- Sphenoidal approach) | $1,065.45 |
| R181 | Respiratory Surgical Procedures-Nose-Excision of nasopharyngeal or oropharyngeal lesion-With palatal split | $508.20 |
| S018 | Oral Cavity and Pharynx-Excision-Glossectomy-Partial | $197.45 |
| S043 | Salivary Glands and Ducts-Excision-Parotid gland-Total (with preservation of facial nerve) | $885.75 |
| S063 | Oral Cavity and Pharynx-Excision-Branchial-Tonsillectomy and may include adenoidectomy | $178.35 |
| S065 | Oral Cavity and Pharynx-Excision-Branchial-Adenoidectomy | $101.25 |
| S068 | Oral Cavity and Pharynx-Excision-Closure of fistula-Pharyngo- Laryngectomy | $1,155.45 |
| S236 | Endoscopic Ultrasound-Linear or radial echo- Endoscope-Excluding biliary or pancreatic examination (scope also used for therapeutic procedures) | $203.05 |
| S237 | Endoscopic Ultrasound-Linear or radial echo- Endoscope-Including biliary and/or pancreatic examination (scope also used for therapeutic procedures) | $253.80 |
| Z292 | Laryngoscopy Direct without biopsy | $61.30 |
| Z293 | Laryngoscopy Direct with biopsy | $61.30 |
| Z296 | Nose-Endoscopy-Fiberoptic endoscopy of upper airway (nose, hypopharynx or larynx) (IOP)-With flexible endoscope-If only operative procedure performed | $20.10 |
| Z299 | Nose-Endoscopy-Fiberoptic endoscopy of upper airway (nose, hypopharynx or larynx) (IOP)-With rigid endoscope, for Diagnostic evaluation, or to facilitate biopsy or surgical treatment of pathology in the posterior nasal cavity, hypopharynx or larynx | $8.55 |
| Z301 | Nose-Incision-Drainage of abscess or haematoma | $55.60 |
| Z302 | Nose-Incision-Turbinate reduction-Unilateral or bilateral (by any method) | $55.60 |
| Z305 | Nose-Excision-Nasal polyp-Multiple or involving general anaesthetic-Unilateral | $55.60 |
| Z311 | Nose-Excision-Removal of foreign body-Local anaesthetic | $10.55 |
| Z312 | Nose-Excision-Removal of foreign body-General anaesthetic | $50.90 |
| Z314 | Nose-Treatment of epistaxis (nasal Haemorrhage)-Cauterization-Unilateral | $11.50 |
| Z315 | Nose-Treatment of epistaxis (nasal Haemorrhage)-Anterior packing-Unilateral | $15.35 |
| Z316 | Nose-Treatment of epistaxis (nasal Haemorrhage)-Posterior packing-Unilateral or bilateral | $35.50 |
| Z317 | Nose-Endoscopy-Fiberoptic endoscopy of upper airway (nose, hypopharynx or larynx) (IOP)-Examination under anaesthesia (EUA) of nose including suction cautery for posterior epistaxis-Unilateral or bilateral | $112.05 |
| Z318 | Accessory Nasal Sinuses-Endoscopic approach-Trephine or endoscopic frontal sinusotomy | $133.30 |
| Z322 | Larynx-Endoscopy-Direct-With removal of foreign body | $106.45 |
| Z323 | Larynx-Endoscopy-Direct-With removal of lesion(s) | $226.35 |
| Z324 | Larynx-Endoscopy-Indirect-With biopsy or removal of foreign body | $44.70 |
| Z325 | Trachea and Bronchi-Incision-Emergency tracheotomy | $474.65 |
| Z326 | Trachea and Bronchi-Tracheo-Bronchial aspiration-Change of tracheostomy tube | $12.50 |
| Z327 | Trachea and Bronchi-Endoscopy-Bronchoscopy-Flexible or rigid, with or without bronchial biopsy, suction or injection of contrast material | $124.90 |
| Z329 | Chest Wall and Mediastinum-Endoscopy-Mediastinoscopy | $380.00 |
| Z331 | Lungs and Pleura-Introduction-Thoracentesis-Aspiration for Diagnostic sample | $32.45 |
| Z332 | Lungs and Pleura-Introduction-Thoracentesis-Aspiration with therapeutic drainage with or without Diagnostic sample | $59.15 |
| Z334 | Lungs and Pleura-Introduction-Thoracentesis-Total unilateral lung lavage with or without bronchoscopy using Double Lumen Tube and single lung anaesthesia | $304.60 |
| Z335 | Thoracoscopy (pleuroscopy) with or without pleural biopsy, suction, etc. | $242.35 |
| Z336 | Lungs and Pleura-Incision-Biopsy of pleura, needle-Including Diagnostic aspiration | $59.15 |
| Z338 | Lungs and Pleura-Excision-Biopsy of pleura or lung-With limited thoracotomy | $202.80 |
| Z340 | Lungs and Pleura-Incision-biopsy of lung, needle | $137.85 |
| Z341 | Lungs and Pleura-Incision-Closed drainage effusion or pneumothorax | $76.80 |
| Z342 | Trachea and Bronchi-Limited bronchoscopy with placement of endobronchial blocker and/or double lumen tube | $112.55 |
| Z343 | Larynx-Endoscopy-Direct-With dilatation of larynx, to include bronchoscopy if necessary | $202.35 |
| Z344 | Trachea and Bronchi-Tracheo-Bronchial aspiration-First procedure | $45.95 |
| Z345 | Trachea and Bronchi-Tracheo-Bronchial aspiration-Subsequent procedures performed by same physician | $18.60 |
| Z346 | Trachea and Bronchi-Tracheo-Bronchial aspiration-Transtracheal aspiration | $22.35 |
| Z350 | Accessory Nasal Sinuses-Endoscopic approach-Ethmoidectomy/antrostomy-Endoscopic sphenoidotomy-Unilateral | $123.70 |
| Z355 | Trachea and Bronchi-Quadroscopy or panendoscopy-With or without biopsy (nasopharyngoscopy, laryngoscopy, bronchoscopy, oesophagoscopy with or without gastro-duodenoscopy) using separate instruments in search of malignant disease | $321.45 |
| Z356 | Trachea and Bronchi-Tracheo-Bronchial aspiration-Closure of persistent tracheostoma | $133.95 |
| Z359 | Trachea and Bronchi-Repeat bronchoscopy for tracheobronchial toilet when performed within one week of another bronchoscopic procedure | $56.65 |
| Z360 | Trachea and Bronchi-Endoscopy-Bronchoscopy-Emergency rigid bronchoscopy for obstructed airway | $474.65 |
| Z361 | Lungs and Pleura-Incision-Chronic indwelling pleural catheter for palliative management of malignant pleural effusion-Insertion of indwelling catheter | $200.00 |
| Z399 | Oesophagus-Endoscopy-Oesophagoscopy- Gastroscopy, with or without duodenoscopy-Elective | $92.50 |
| Z400 | Oesophagus-Endoscopy-Oesophagoscopy- Gastroscopy, with or without duodenoscopy-for active bleeding | $125.10 |
| Z515 | Oesophagus-Endoscopy-Oesophagoscopy, with or without biopsy(ies) | $68.25 |
| Z524 | Oral Cavity and Pharynx-Incision-Drainage of haematoma or deep neck abscess (external approach) | $271.05 |
| Z527 | Stomach-Endoscopy-Gastroscopy-May include biopsies, photography and removal of polyps less than or equal to 1 cm | $82.90 |
| Z528 | Gastroscopy-subsequent (within three months following previous gastroscopy) | $67.85 |
| Z547 | Stomach-Endoscopy-Gastroscopy-With removal of foreign body | $99.75 |
| Z558 | Biliary Tract-Endoscopy-Endoscopic retrograde cholangiopancreatography (ERCP)-Including sphincterotomy and may include removal of one or more bile duct stones | $300.25 |
| Z561 | Biliary Tract-Endoscopy-Endoscopic retrograde cholangiopancreatography (ERCP)-With cannulation of common bile duct and/or pancreatic duct | $213.15 |
| Z584 | Intestines (except rectum)-Endoscopy-Small bowel push enteroscopy | $185.15 |
| Z738 | Trachea and Bronchi-Incision-Insertion of Montgomery “T” Tube or similar laryngeal or tracheal stent | $216.10 |
| Z741 | Trachea and Bronchi-Incision-Tracheotomy | $273.15 |
| Z760 | Biliary Tract-Endoscopy-Endoscopic retrograde cholangiopancreatography (ERCP)-Through gastrojejunostomy following previous Billroth II | $251.85 |
AGMPs to be Added to the Eligible List
The following procedures, when requiring the use of a high-speed device in the respiratory tract, are eligible for the AGMP premium when performed on patients who are COVID-19 positive or who are treated as at risk of COVID-19 positive:
| Fee Schedule Code | Descriptor | April 2020 Price |
|---|---|---|
| F138 | Mandible-Closed reduction, includes maxillary-mandibular fixation | $350.00 |
| F139 | Mandible-Open reduction, per fracture, to include intermaxillary fixation | $575.00 |
| F140 | Mandible-Removal of intermaxillary fixation device(s) | $100.00 |
| E173 | Orbit-Open reduction rim/wall fracture-Zygomatic fracture dislocation | $594.70 |
| E174 | Orbit-Blowout fracture of floor | $667.00 |
| F143 | Midface fractures-Application of craniofacial suspension wires and external fixation devices (not to be billed in addition to maxillary repair)-Middle ¼ facial | $577.65 |
| F144 | Midface fractures-Application of craniofacial suspension wires and external fixation devices (not to be billed in addition to maxillary repair)-Cranial-facial separation | $1,594.90 |
| F142 | Orbit with maxilla-With wiring and local fixation | $685.20 |
| M063 | Maxillectomy-Coronal and/or osteoplastic procedure for frontal sinusectomy, reconstruction or obliteration-Unilateral or bilateral | $716.25 |
Additional eligible procedures when requiring open suctioning of the airway:
| Fee Schedule Code | Descriptor | April 2020 Price |
|---|---|---|
| Z317 | Endoscopy-Examination under anaesthesia (EUA) of nose including suction cautery for posterior epistaxis-Unilateral or bilateral | $112.05 |
| Z314 | Treatment of epistaxis (nasal haemorrhage)-Cauterization-Unilateral | $11.50 |
| E839 | Excision-Nasal polyp-With flexible endoscope, to Z304 | $19.20 |
| M027 | Treatment of epistaxis (nasal haemorrhage)-Ligation of external carotid artery-Unilateral | $297.25 |
| R788 | Treatment of epistaxis (nasal haemorrhage)-Ligation of internal maxillary artery-Unilateral | $408.10 |
| R789 | Treatment of epistaxis (nasal haemorrhage)-Ligation of anterior ethmoidal artery-Unilateral | $299.85 |
| Z313 | Treatment of epistaxis (nasal haemorrhage)-Endoscopic transnasal ligation of the sphenopalatine artery for posterior epistaxis-Unilateral | $123.70 |
| M144 | Segmental resection, including segmental bronchus and artery | $1,441.75 |
Keywords/tags
COVID-19; Aerosol-Generating Medical Procedures; AGMP; modifier payment.
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