Keeping Health Care Providers informed of payment, policy or program changes

To: Providers
Published by: Claims Services Branch, Ministry of Health
Date Issued: June 8, 2020

The Ministry of Health (the ministry) has implemented new temporary payments for physician services in hospital as a result of COVID-19.

Effective April 3, 2020, the ministry has implemented a new temporary fee code to enable the processing of the temporary modifier hospital payment for Aerosol Generating Medical Procedures (AGMP). This new fee schedule code (FSC) is part of the larger new COVID-19 temporary payments for physician services in hospital.

The new fee schedule code used to process the hospital AGMP modifier payment to physicians is:

  • E405A: COVID Hospital Complexity Modifier

E405A should only be billed for patients who are COVID-19 positive or who are treated as at risk of COVID-19 positive under local hospital policy. This FSC can only be billed with general anesthesia and certain procedures which are listed in Appendix A.

E405A can only be billed for eligible procedures with a service date in the following period of time: April 3, 2020 to July 31, 2020. E405A will be paid at 30% of the fee paid value (fee approved for shadow billed claims) of the applicable services for the same patient, same physician on the same day.

Fee for Service Claim Submissions:

  • A Master Number is required to be submitted with the E405A FSC
  • E405A does not require a diagnostic code
  • When E405A is billed with a Northern Specialist Hospital-based group number (group numbers 64AA-64DZ) the 30% premium will be calculated on the pre-reduction amount
  • The E405A is payable on the sum of fee paid (fee approved for shadow billed claims) for all eligible claims, submitted on the same claim or previously paid claims with same service date, same physician, and same patient
  • E405A is a daytime premium for services that commence between 7:00 a.m. and 5:00 p.m. on weekdays (not to be used for services on weekends or holidays).
  • E405A is not payable with E400C, E401C, E409A, E410A, E412A, E413A, Q012A, Q016A, Q017A and Q018A (after-hours premiums)
  • Travel, first and additional persons seen premiums are eligible for payment with E405A for the same patient, same physician, same service date
  • E405A is not eligible to be billed with virtual care claims

Appendix A-Aerosol Generating Medical Procedures (AGMP)

Fee Schedule CodeDescriptorApril 2020 Value
AnaesthesiaAnaesthesia unit fee$15.29
E600Larynx-Endoscopy- Laryngoscopy- Using operating microscope-To charges for laryngoscopy add$33.60
G050Trachea and Bronchi-Endoscopy-Bronchoscopy-Endobronchial ultrasound (EBUS), for guided biopsy of hilar and/or mediastinal lymph nodes$203.05
G579Echocardiography-Transoesophageal echocardiography-Saline study (including venipuncture, to G571, G574, G581 or G584 add$11.35
G580Echocardiography-Transoesophageal echocardiography-Insertion of oesophageal transducer$45.00
G581Echocardiography-Transoesophageal echocardiography-professional component (P1)$25.00
M054Accessory Nasal Sinuses-Endoscopic approach-Intranasal maxillary antrostomy -unilateral -by endoscopic or endonasal approach$123.70
M055Accessory Nasal Sinuses-External Or Endonasal Approach-Maxillary-Caldwell- Luc (includes intranasal antrostomy)-Unilateral$247.35
M056Accessory Nasal Sinuses-Maxillectomy-Partial or complete$971.75
M061Accessory Nasal Sinuses-External Or Endonasal Approach-Sphenoid-Trans- Septal sphenoidectomy for tumour or radical exenteration of disease$355.65
M083Accessory Nasal Sinuses-Ethmoidectomy/antrostomy-Intranasal ethmoidectomy including maxillary antrostomy, with endoscope -unilateral (not eligible for payment with M061 or M054)$350.00
M084Larynx-Excision-Laryngectomy-Segmental, including reconstruction$888.85
M086Accessory Nasal Sinuses-Ethmoidectomy/antrostomy- Trans- Nasal endoscopic repair of CSF rhinorrhea (includes harvesting of graft material) with or without 3D CT/MRI image guided system$822.45
M105Chest Wall and Mediastinum-Excision-Chest wall tumour, resection of 2 or 3 ribs or cartilages$650.00
M135Lungs and Pleura-Incision-Major decortication of lung for empyema or tumour$848.80
M137Respiratory /Cardiovascular Surgical Procedures-Lungs and pleura-Incision-Multi-Thoracotomy with or without biopsy$390.65
M142Lungs and Pleura-Excision-Pneumonectomy, may include radical mediastinal node dissection, sampling or pericardial resection requiring repair$1,485.40
M143Lungs and Pleura-Excision-Lobectomy, may include radical mediastinal node dissection or sampling$1,402.60
M145Lungs and Pleura-Excision-Wedge resection of lung$843.40
M149Lungs and Pleura-Excision-Pleurectomy, and/or apical bullectomy for pneumothorax$525.00
M151Lungs and Pleura-Excision-Bullectomy for major bullous disease$725.00
N111Cranial-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
N112Cranial-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
N114Cranial-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
N116Cranial-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
N150Cranial-Cerebral Injury-C.S.F. leak-Intracranial repair (to include trans- Sphenoidal approach)$1,065.45
R181Respiratory Surgical Procedures-Nose-Excision of nasopharyngeal or oropharyngeal lesion-With palatal split$508.20
S018Oral Cavity and Pharynx-Excision-Glossectomy-Partial$197.45
S043Salivary Glands and Ducts-Excision-Parotid gland-Total (with preservation of facial nerve)$885.75
S063Oral Cavity and Pharynx-Excision-Branchial-Tonsillectomy and may include adenoidectomy$178.35
S065Oral Cavity and Pharynx-Excision-Branchial-Adenoidectomy$101.25
S068Oral Cavity and Pharynx-Excision-Closure of fistula-Pharyngo- Laryngectomy$1,155.45
S236Endoscopic Ultrasound-Linear or radial echo- Endoscope-Excluding biliary or pancreatic examination (scope also used for therapeutic procedures)$203.05
S237Endoscopic Ultrasound-Linear or radial echo- Endoscope-Including biliary and/or pancreatic examination (scope also used for therapeutic procedures)$253.80
Z292Laryngoscopy Direct without biopsy$61.30
Z293Laryngoscopy Direct with biopsy$61.30
Z296Nose-Endoscopy-Fiberoptic endoscopy of upper airway (nose, hypopharynx or larynx) (IOP)-With flexible endoscope-If only operative procedure performed$20.10
Z299Nose-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
Z301Nose-Incision-Drainage of abscess or haematoma$55.60
Z302Nose-Incision-Turbinate reduction-Unilateral or bilateral (by any method)$55.60
Z305Nose-Excision-Nasal polyp-Multiple or involving general anaesthetic-Unilateral$55.60
Z311Nose-Excision-Removal of foreign body-Local anaesthetic$10.55
Z312Nose-Excision-Removal of foreign body-General anaesthetic$50.90
Z314Nose-Treatment of epistaxis (nasal Haemorrhage)-Cauterization-Unilateral$11.50
Z315Nose-Treatment of epistaxis (nasal Haemorrhage)-Anterior packing-Unilateral$15.35
Z316Nose-Treatment of epistaxis (nasal Haemorrhage)-Posterior packing-Unilateral or bilateral$35.50
Z317Nose-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
Z318Accessory Nasal Sinuses-Endoscopic approach-Trephine or endoscopic frontal sinusotomy$133.30
Z322Larynx-Endoscopy-Direct-With removal of foreign body$106.45
Z323Larynx-Endoscopy-Direct-With removal of lesion(s)$226.35
Z324Larynx-Endoscopy-Indirect-With biopsy or removal of foreign body$44.70
Z325Trachea and Bronchi-Incision-Emergency tracheotomy$474.65
Z326Trachea and Bronchi-Tracheo-Bronchial aspiration-Change of tracheostomy tube$12.50
Z327Trachea and Bronchi-Endoscopy-Bronchoscopy-Flexible or rigid, with or without bronchial biopsy, suction or injection of contrast material$124.90
Z329Chest Wall and Mediastinum-Endoscopy-Mediastinoscopy$380.00
Z331Lungs and Pleura-Introduction-Thoracentesis-Aspiration for Diagnostic sample$32.45
Z332Lungs and Pleura-Introduction-Thoracentesis-Aspiration with therapeutic drainage with or without Diagnostic sample$59.15
Z334Lungs and Pleura-Introduction-Thoracentesis-Total unilateral lung lavage with or without bronchoscopy using Double Lumen Tube and single lung anaesthesia$304.60
Z335Thoracoscopy (pleuroscopy) with or without pleuralBiopsy, suction, etc.$242.35
Z336Lungs and Pleura-Incision-Biopsy of pleura, needle-Including Diagnostic aspiration$59.15
Z338Lungs and Pleura-Excision-Biopsy of pleura or lung-With limited thoracotomy$202.80
Z340Lungs and Pleura-Incision-biopsy of lung, needle$137.85
Z341Lungs and Pleura-Incision-Closed drainage effusion or pneumothorax$76.80
Z342Trachea and Bronchi-Limited bronchoscopy with placement of endobronchial blocker and/or double lumen tube$112.55
Z343Larynx-Endoscopy-Direct-With dilatation of larynx, to include bronchoscopy if necessary$202.35
Z344Trachea and Bronchi-Tracheo-Bronchial aspiration-First procedure$45.95
Z345Trachea and Bronchi-Tracheo-Bronchial aspiration-Subsequent procedures performed by same physician$18.60
Z346Trachea and Bronchi-Tracheo-Bronchial aspiration-Transtracheal aspiration$22.35
Z350Accessory Nasal Sinuses-Endoscopic approach-Ethmoidectomy/antrostomy-Endoscopic sphenoidotomy-Unilateral$123.70
Z355Trachea 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
Z356Trachea and Bronchi-Tracheo-Bronchial aspiration-Closure of persistent tracheostoma$133.95
Z359Trachea and Bronchi-Repeat bronchoscopy for tracheobronchial toilet when performed within one week of another bronchoscopic procedure$56.65
Z360Trachea and Bronchi-Endoscopy-Bronchoscopy-Emergency rigid bronchoscopy for obstructed airway$474.65
Z361Lungs and Pleura-Incision-Chronic indwelling pleural catheter for palliative management of malignant pleural effusion-Insertion of indwelling catheter$200.00
Z399Oesophagus-Endoscopy-Oesophagoscopy- Gastroscopy, with or without duodenoscopy-Elective$92.50
Z400Oesophagus-Endoscopy-Oesophagoscopy- Gastroscopy, with or without duodenoscopy-for active bleeding$125.10
Z515Oesophagus-Endoscopy-Oesophagoscopy, with or without biopsy(ies)$68.25
Z524Oral Cavity and Pharynx-Incision -Drainage of haematoma or deep neck abscess (external approach)$271.05
Z527Stomach-Endoscopy-Gastroscopy-May include biopsies, photography and removal of polyps less than or equal to 1 cm$82.90
Z528Gastroscopy-subsequent (within three months following previous gastroscopy)$67.85
Z547Stomach-Endoscopy-Gastroscopy-With removal of foreign body$99.75
Z558Biliary Tract-Endoscopy-Endoscopic retrograde cholangiopancreatography (ERCP)-Including sphincterotomy and may include removal of one or more bile duct stones$300.25
Z561Biliary Tract-Endoscopy-Endoscopic retrograde cholangiopancreatography (ERCP)-With cannulation of common bile duct and/or pancreatic duct$213.15
Z584Intestines (except rectum)-Endoscopy-Small bowel push enteroscopy$185.15
Z738Trachea and Bronchi-Incision-Insertion of Montgomery “T” Tube or similar laryngeal or tracheal stent$216.10
Z741Trachea and Bronchi-Incision-Tracheotomy$273.15
Z760Biliary Tract-Endoscopy-Endoscopic retrograde cholangiopancreatography (ERCP)-Through gastrojejunostomy following previous Billroth II$251.85

For any further inquiries, please contact the Service Support Contact Centre at 1-800-262-6524.