Bulletin 230310 — Physician Services Agreement related adjustments to the Schedule of Benefits
The temporary 2.01% global increase to physician payments will be replaced with targeted fee code adjustments
To: All Physicians and Hospitals
Category: Physician Services
Written by: Provider Services Branch, Physician and Provider Services Division
Date issued: March 30, 2023
New: Physician Services Agreement initiatives effective April 1, 2023
The Ministry of Health (‘the Ministry’) and the Ontario Medical Association (OMA) have been working together to implement physician compensation changes agreed to under the 2021 Physicians Services Agreement (PSA).
On April 1, 2023, the temporary 2.01% global increase to physician payments for services rendered between April 1, 2022 and March 31, 2023 will be replaced by permanent fee code adjustments as per the financial agreement of the PSA.
These permanent fee code adjustments will reallocate the temporary across-the-board payment increases to achieve targeted investments in priority areas.
The permanent fee code adjustments result from recommendations made by the Physician Payment Committee (PPC), a bilateral committee established under the PSA.
Payment adjustments within each specialty section or physician grouping vary in accordance with the relativity percentage increases outlined in the PSA.
New Schedule Section for Critical Care Medicine with related fee code listings
- A new section is being added to the Schedule to provide fee code listings for Critical Care Medicine specialists.
- Providers with OHIP specialty designations in Critical Care Medicine (11) should utilize these fee codes when submitting claims for applicable Critical Care Medicine services rendered on or after April 1, 2023.
Additional changes to the Schedule
The targeted compensation adjustments being implemented under the PSA involve the Schedule changes listed below.
New fee schedule codes effective April 1, 2023
The following table shows new fee schedule codes coming into effect for services rendered from April 1, 2023 onward.
Delisted fee schedule codes with end date of March 31, 2023
The following table shows delisted fee schedule codes with end dates of March 31, 2023.
Fee schedule code revisions effective April 1, 2023
The following table shows fee schedule codes with revisions coming into effect for services rendered from April 1, 2023 onward.
Fee schedule code value changes effective April 1, 2023
The following table shows Fee Schedule Code value changes coming into effect for services rendered from April 1, 2023 onward.
Technical fee values effective April 1, 2023
- All technical services will continue to pay at the 2.01% increased rate applied April 1, 2022 with the exception of technical services performed in hospital
- Technical services performed in hospital are defined as those with a Service Location Indicator of HED (hospital emergency department), HOP (hospital out-patient), HDS (hospital day surgery), HRP (hospital referred patient)
- Note that HIP (hospital in-patient) technical fees are disallowed
Unit fee increases effective April 1, 2023
- The Assistant Unit Fee will be increased to $12.51
- The Anaesthesiologist Unit Fee will be increased to $15.49
Medical Claims Adjustments (MADJ)
Due to staged implementations, Medical Claims Adjustments (MADJ) will be required. Further information will be provided in advance of any implementation of a Medical Claims Adjustment.
- 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.
- There will be a number of claims reprocessed with no change in payment. These will typically appear on the Remittance Advice 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 out to zero with no payment impact but will report on the Remittance Advice for reconciliation purposes.
Primary Care and Specialist Contract-Based Payments
This INFOBulletin describes PSA-related adjustments to the Schedule of Benefits that impact OHIP Claims System Payments (example, fee-for-service physician payments). Additional communications will be published to describe PSA-related changes to other payments such as those made under contracts or through other programs.
Update your billing software
Please ensure that your billing software is updated to reflect the new FSC values for any services rendered on or after April 1, 2023, before submitting your claims.
The updated Fee Schedule Master can be found on the Ministry of Health website. This file will be available for download by April 6, 2023.
Education and Prevention Committee Resources
The Ministry of Health (MOH) and the Ontario Medical Association (OMA) have jointly established the Education and Prevention Committee (EPC). Since 2003, the Education and Prevention Committee has developed education resources for physicians about submitting OHIP claims for payment for the insured service provided.
Your feedback is welcome and appreciated. To provide feedback on EPC Billing Briefs, or to suggest topics for future EPC Billing Briefs, send an email to the attention of the joint Ministry of Health and OMA Education and Prevention Committee.
Physician Services Agreement; PSA; Physician Payment Committee; PPC; payments