Bulletin 201203 — Medical Claims Adjustment for S207A, G496A and K181A
Previously paid fee schedule codes S207A, G496A and K181A will be subject to a Medical Claims Adjustment (MADJ).
To: Physicians, Hospitals, Clinics and Laboratories
Category: Physician Services
Written by: Claims Services Branch, Ontario Health Insurance Plan Division
Date issued: December 17, 2020
Further to INFOBulletin 201103 titled ‘Kaplan Year 4 changes to S207A, G496A, K181A and G601A’, a Medical Claims Adjustment (MADJ) was required to reprocess claims for the Fee Schedule Codes (FSCs) listed below. The new rules for these FSCs were implemented October 1, 2020, with an effective date of April 1, 2020.
- S207A-Appendectomy, intact or ruptured
- G496A-Electroencephalogram (EEG) with time-locked video recording
- K181A-Management of Acute Cerebral Vascular syndrome with peripheral tPA
Medical Claims Adjustments (MADJ)
- Claims already submitted for S207A, G496A and K181A with service dates between April 1, 2020 and September 30, 2020 that were previously paid were subject to the MADJ. If necessary, these claims were adjusted in accordance with the changes to the Schedule of Benefits for Physician Services effective April 1, 2020.
- Adjustments will appear on the December 2020 Remittance Advice (RA).
- Please also note that during the MADJ process, the claims processing system selects an entire claim and reprocesses it. A single claim can include multiple fee schedule codes and all codes will be reprocessed.
- Claims that were reprocessed with no change in payment will appear on the Remittance Advice (RA) with explanatory code ’55-This deduction is an adjustment on an earlier account’ and ’57-This payment is an adjustment on an earlier account’. These two transactions will net to zero with no payment impact but will report on the RA for reconciliation purposes.
S207A; G496A; K181A; Year 4; Kaplan