Bulletin 230322 — Year 3 Increase: Group Health Centre
Permanent adjustments of the Year 1 and Year 2 increases will be effective April 1, 2023.
To: Group Health Centre (GHC) Physicians
Category: Primary Health Care Services, Physician Services
Written by: Negotiations Branch, Physician and Provider Services Division
Date issued: March 31, 2023
The Ministry of Health and the Ontario Medical Association have been working together to implement physician compensation increases in accordance with the 2021 Physician Services Agreement (PSA).
The PSA provides for Year 1 and Year 2 compensation increases to be implemented as permanent adjustments to physician payments effective April 1, 2023. The permanent increase amounts vary according to relativity as outlined in the PSA. They are allocated to each section or physician grouping, as per page 6 of the Financial Agreement of the PSA.
Blended Fee-For-Service (BFFS) premium increase
Effective April 1, 2023, Blended Fee-For-Service (BFFS) premium payments will increase from 10% to 15% of the approved amount on all shadow-billed claims.
Hard Cap threshold increase
Effective April 1, 2023, the Fee-For-Service billing limits for core services provided to non-enrolled patients (the Hard Cap) will be increased by 2.6186%.
New Fee Schedule codes effective April 1, 2023
Effective April 1, 2023, the following new services have been introduced. The services when billed with a ‘C-Suffix’ have been added to the basket of ‘Excluded Codes’ for the Group Health Centre patient enrolment model.
| Fee Code | Description |
|---|---|
| E182C | Strabismus procedures-Transposition of extraocular muscle to treat paretic or lost, damaged eye muscle |
| E183C | Strabismus procedures-superior oblique muscle (per muscle) |
| E184C | Strabismus procedures-inferior oblique muscle (per muscle) |
| E185C | Strabismus procedures-horizontal or vertical rectus muscle (per muscle) |
| M112C | Sternal debridement and rewiring with or without special mechanical instrumentation-as sole procedure |
| N291C | Nerve transfer-major-(mixed sensory and motor nerve, or pure motor nerve) |
| N293C | Nerve transfer-minor-(sensory/cutaneous nerve) |
| R102C | Level 1 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancy |
| R158C | Level 2 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancy |
| R159C | Level 3 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancy |
| R740C | Left atrial appendage occlusion/excision by suture or device, Sole procedure |
| Z516C | Excision of first polyp (20 mm to 29 mm) |
| Z517C | Excision of first polyp (10 mm to 19 mm) |
| Z518C | Excision of first polyp (6 mm to 9 mm) |
| Z844C | Diagnostic Paracentesis for: 1) suspected intraocular infection; 2) intraocular inflammation / uveitis; or 3) suspected cancer involving the intraocular structures or fluids |
Deleted Fee Schedule codes Effective April 1, 2023
Effective April 1, 2023, the following services have been delisted and removed from the basket of ‘Excluded Codes’ for the Group Health Centre patient enrolment model.
| Fee Code | Description |
|---|---|
| E158C | Retina and Extraocular Muscles-Repair-Strabismus procedures-Two muscles, one or both eyes |
| E159C | Strabismus procedure one muscle one or both eyes |
| E162C | Strabismus procedure-three or more muscles, one or both eyes |
| H400 | Emergency Department Sessional Fees-Sessions-Mon-Fri (other than holidays)-2000h-2400h |
| H401 | Emergency Department Sessional Fees-Sessions-Mon-Fri-Monday-Friday (other than holidays)-0000h-0400h |
| H402 | Emergency Department Sessional Fees-Sessions-Mon-Fri-Monday-Friday (other than holidays)-0400)-0400h-0800h |
| H403 | Emergency Department Sessional Fees-Sessions-Sat, Sun, Holidays-0000h-0400h |
| H404 | Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-0400h-0800h |
| H405 | Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-0800h-1200h |
| H406 | Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-1200h-1600h |
| H407 | Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-1600h-2000h |
| H408 | Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-2000h-2400h |
| R849C | Dialysis-Haemodialysis-Initial and acute (includes both medical and surgical components) |
| R850C | Dialysis-Haemodialysis-Surgical component alone-Insertion of Scribner shunt |
| Z408C | Bone marrow core biopsy (with biopsy needle) |
| Z450C | Dialysis-Revision of Scribner shunt-Single |
| Z451C | Dialysis-Revision of Scribner shunt-Both |
| Z570C | Intestines (except rectum-)-Fulguration of first polyp through colonoscope |
New service eligible for after-hours
Effective April 1, 2023, the new service ‘K133A-Periodic Health Visit for Adults with Intellectual and Developmental Disabilities’ is eligible for the after-hours premium when billed with a Q012A for enrolled patients.
Fee Schedule code increases effective April 1, 2023
Effective April 1, 2023, the Fee Schedule Master (FSM) will be updated to reflect new values for fee-for-service (FFS) codes as agreed to between the ministry and the OMA at the Physician Payment Committee (PPC). For more information, please see INFOBulletin 230310.
Specialist services
Effective April 1, 2023, the base salary amounts for Fera Medical Professional Corporation physician specialists will be increased by the approved percentage for each specialty classification. These increased payments will be reflected in your Monthly Transfer Payment as soon as possible.
Keywords/Tags
Physician Services Agreement; PSA; physicians; payments
Contact information
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