New payment rules are being applied to Fee Schedule Codes K189A, E514A, E644A, E880A, and E949A

To: All Physicians
Category: Physician Services
Written by: Claims Services Branch; Health Programs and Delivery Division
Date issued: May 8, 2023

Background

The Ministry of Health and the Ontario Medical Association have been working together to implement the 2021 Physician Services Agreement (PSA).

Further to INFOBulletin 230310, permanent Fee Schedule Code and contract adjustments were made effective April 1, 2023.

These changes are being added to the OHIP claims system through staged implementations.

The following Release 2 changes are being implemented May 1, 2023 with an effective date of April 1, 2023.

K189A - Urgent community psychiatric follow-up

The claims payment system will now allow automated payment of K189A in combination with A192A or A198A when all requirements have been met.

E514A - Post mastectomy breast reconstruction - immediate breast reconstruction following mastectomy

The claims payment system will now allow automated payment of E514A in combination with R118A when all requirements have been met.

E644A - Radical mediastinal node dissection following preoperative chemotherapy and/or radiotherapy

The claims payment system will now allow automated payment of E644A in combination with S128A when all requirements have been met.

E880A - Thyroidectomy - parathyroid(s) re-implantation

E880A is only eligible for payment with S788A or S793A.

If E880A is not billed with one of the above Fee Schedule Codes, it will pay at $0 with explanatory code ‘DF-Corresponding fee code has not been claimed or was approved at zero’

E949A - For adjustable suture (to Strabismus Procedures)

The claims payment system will now allow automated payment of E949A in combination with the following fee codes when all requirements have been met:

  • E182A - transposition of extraocular muscle to treat paretic or lost, damaged eye muscle
  • E183A - superior oblique muscle (per muscle)
  • E184A - inferior oblique muscle (per muscle)
  • E185A - horizontal or vertical rectus muscle (per muscle)

If E949A is billed without one of the listed services above, the claim for E949A will pay at $0 with explanatory code ‘DF-Corresponding fee code has not been claimed or was approved at $0’.

Medical Claims Adjustments (MADJ)

Please note, due to staged implementations, a Medical Claims Adjustment may be required.

Further information will be provided in advance of a Medical Claims Adjustment.

Keywords/Tags

K189A; E644A; E880A; E514A; E949A; Physician Services Agreement; PSA; Physician Payment Committee; PPC

Contact information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.