Bulletin 211101 — COVID‑19 Temporary Palliative Virtual Care Service Changes
COVID-19 Temporary Palliative Virtual Care Service Changes
Temporary palliative virtual care services to be allowed with additional Fee Schedule Codes (FSCs)
To: All Providers
Category: Physician Services
Written by: Claims Services Branch, OHIP, Pharmaceuticals and Devices Division
Date issued: November 1, 2021
Temporary Physician Funding Related to COVID-19
To ensure patients may continue to access the heath care they need during the gradual reopening of the province, the Ministry of Health (ministry) and the Ontario Medical Association (OMA) have reached an agreement to extend existing temporary physician funding initiatives under the Ontario Health Insurance Plan (OHIP) to September 30, 2022.
Effective November 1, 2021 a system enhancement was completed to allow additional Fee Schedule Codes (FSCs) to be billed on the same service date as temporary virtual palliative care services, K094A (Virtual Palliative Care Support-Telephone) and K095A (Virtual Palliative Care Support-Video).
These services would have been allowed if the palliative care service had been in-person; therefore, to ensure appropriate payment, the system will now allow the following FSCs to be billed with K094A and K095A for the same patient, by the same physician, on the same service date:
- G512A: Weekly Palliative Care Case Management Fee
- K002A: Interviews with Relatives on Behalf of a Patient
- K015A: Counselling of Relative on Behalf of a Patient
- K070A: Home Care Application
- K121A: Hospital In-Patient Case Conference
- K124A: Long-Term Care/CCAC Case Conference
- K700A: Palliative Care Out-Patient Case Conference
- K705A: Long-Term Care-High Risk Patient Conference
Claims Processing
Eligible claims submitted on or after November 1, 2021 for the above services on the same service date for the same patient by the same physician as K094A or K095A will be processed by the claims system accordingly.
As these changes are retroactive, a medical claims adjustment (MADJ) will be required. This MADJ will reprocess previously submitted claims for service dates between March 14, 2021 and October 31, 2021, that were previously paid at $0. Further details relating to the MADJ will be communicated in a future INFOBulletin.
A stale-date exemption has been applied to the above FSCs until December 31, 2021 for submissions with service dates approaching the end of their 6-month stale-date submission deadlines.
For additional information regarding these FSCs, refer to INFOBulletin #210605 -COVID-19 Temporary Virtual Palliative Care Services.
The Schedule of Benefits for Physician Services
The latest version of the Schedule of Benefits for Physician Services is available on the Ministry of Health website. Hard copies of the Schedule of Benefits for Physician Services will not be distributed. If you would like to order a paper copy or compact disk (CD) of the Schedule for a fee, please visit Publications Ontario. Physicians without access to the Internet can contact ServiceOntario at
Keywords/tags
OHIP; Physicians; COVID-19; Palliative; Virtual; Telephone; Video
Contact information
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