Bulletin 4760 — COVID‑19 Temporary Fee Schedule Code (FSC) K083A and Assessment Centre FSCs H409A and H410A
Keeping Health Care Providers informed of payment, policy or program changes
Published by: Claims Services Branch, Ministry of Health
Date Issued: June 15, 2020
Further to INFOBulletin #4755, when submitting claims for K083A-Specialist consultation or visit by telephone or video payable in increments of $5.00, the physician should submit the number of services necessary to make the total payment under the K083A equivalent to the consultation or visit provided, rounded to the nearest $5.00.
- For consultation or visit FSCs using time units, calculate units by taking the consultation or visit fee and rounding it to the nearest $5, then divide that number by 5. For example, K197A-Individual out-patient psychotherapy (in person) using 2 units or 46 minutes minimum is $173.70 ($86.85 per unit). Round that number to the nearest $5 ($175) and then divide by 5 = 35 units. Physicians should submit 35 as the number of services on the claim and a fee billed of $175. (K083A x 35 billed at $175.00.)
- For consultation or visit FSCs not based on time units, round to the nearest $5 and divide by 5. For example, an A485A consultation is $170.10. This rounds to $170 or 34 units. This code would be submitted with a fee billed at $170 and the number of services equal to 34. (K083A x 34 billed at $170.00.)
Note: If a claim is submitted as one service with a fee billed value of $5 the claim will be paid at $5.00.
Assessment Centre Fee Schedule Codes H409A and H410A
- H409A and H410A must be billed with the unique group number assigned to each individual Assessment Centre.
- The Health Number field on the claim must be left blank. If a physician submits these claims with a Health Number (HN), the claim will reject ‘VHB-No HN Required for FSC’.
- The Version Code field on the claim must be left blank. If a physician submits these claims with a Version Code, the claim will reject ‘VHB-No HN Required for FSC’.
- The Birth Date field on the claim must be left blank. If a physician submits these claims with a value in the Birth Date, the claim will reject ‘VH1-Invalid Health Number’.
- The Service Date on the claim will be the date the service was provided.
- The claim must be submitted with a fee billed value not equal to $0.00. If a physician submits these claims with a fee billed value of $0.00, the claim will pay $0.00.
For further inquiries, please contact the Service Support Contact Centre