Bulletin 230504 — K900A biosimilar support fee billing requirements
The K900A fee schedule code must be billed alone
To: All physicians
Category: Physician Service
Written by: Claims Services Branch, Health Programs and Delivery Division
Date issued: May 15, 2023
Overview
The new Fee Schedule Code (FSC) ‘K900A - Biosimilar Support Fee’ has been created to support expanding the use of biosimilar drug treatments for Ontarians. As a reminder, Ontario Drug Benefit (ODB) recipients who are on an originator biologic will be required to transition to the biosimilar version by December 29, 2023.
Please note that K900A must be billed alone (submitted separately from other FSCs) to ensure accurate processing.
Claim processing
The K900A Fee Schedule Code must be submitted alone on a claim to ensure payment. K900A is eligible for payment on the same date of service as other services, however, it must not be on the same claim.
Submit K900A on a separate claim from any other service(s) to ensure payment.
K900A can only be provided under payment program Health Claims Payment (HCP), by a physician (OHIP billing number in the range of 000001 to 299999). Please reference INFOBulletin 230302 for further information on this code.
If you receive any claims processing errors or do not receive payment, please resubmit K900A on its own claim.
If you are experiencing issues submitting K900A alone through your billing software, please contact your software vendor.
Keywords/Tags
Biosimilar; Ontario Drug Benefit Program; ODB; Biologics; Exceptional Access Program; EAP; K900A
Contact information
Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call