Bulletin 210904 — Virtual Care Services Require Modality Indicators
COVID-19 temporary virtual care services will require a modality indicator tracking code effective October 1, 2021.
To: All Physicians
Category: Physician Services
Written by: Claims Services Branch, Ontario Health Insurance Plan Division
Date issued: September 29, 2021
Background
As communicated in INFOBulletin 210704, the Ministry of Health (ministry) and the Ontario Medical Association (OMA) reached an agreement to extend the existing temporary physician funding initiatives under the Ontario Health Insurance Plan (OHIP) to September 30, 2022.
Effective October 1, 2021, the following virtual care Fee Schedule Codes (FSCs) with service dates on or after October 1, 2021 will require a modality indicator tracking code (K300A for video or K301A for phone). This must be submitted with the claim to identify the technology used to deliver the service.
Note: Claims for K080A-K083A services provided on or after October 1, 2021 submitted without a modality indicator tracking code will reject to the provider’s error report.
| Fee Schedule Code | Description | Value |
|---|---|---|
| K080A | Minor assessment of a patient by telephone or video, or advice or information by telephone or video to a patient's representative regarding health maintenance, diagnosis, treatment and/or prognosis. | $23.75 |
| K081A |
| $36.85 |
| K082A | Psychotherapy, psychiatric or primary mental health care, counselling or interview conducted by telephone or video per unit (unit means half hour or major part thereof) per unit | $67.75 |
| K083A | Specialist consultation or visit by telephone or video payable in increments of | $5.00 per increment |
Claims Processing
- Modality indicator tracking codes K300A and K301A will pay at zero dollars ($0) with the explanatory code ‘33-Approved’.
- K300A will identify video technology used during the service.
- K301A will identify audio only (phone) technology used during the service.
- The effective date of K300A and K301A will be for service dates on or after October 1, 2021.
- Either a K300A or K301A need to be submitted on same claim with an approved K080A-K083A (“K-code”) service for same patient, same service date, same physician.
- If a K300A or K301A is submitted alone without a corresponding K-code on the same claim, same service date, the K300A or K301A code will pay at $0 with access explanatory code ‘DF-Corresponding fee code has not been claimed or was approved at zero’.
- If a virtual care K-code (K080A-K083A) is submitted with a service date of October 1, 2021 or later without a modality indicator tracking code on the same claim, same service date, the claim will reject to the provider’s error report with error code ‘VTC-Virtual Tech Code Required’.
- If K300A or K301A is submitted with a service date prior to October 1, 2021, the claim will reject to the provider’s error report with error code ‘A3E-No Such Fee Schedule Code’.
- Only one modality indicator code is eligible per service (K080A-K083A), per patient and service date on the same claim.
- If more than one modality indicator code is submitted with one of the virtual care K-codes on the same claim, same service date, the system will accept K300A and apply the explanatory code ‘D7-Not allowed in addition to other procedure’ to the K301A.
Keywords/tags
OHIP; Physicians; Modality; Indicator; COVID-19; K300; K301; K080; K081; K082; K083; Virtual Care;
Contact information
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