Bulletin 230706 — Diagnostics and consultations requested by non-physicians
Revisions to the Physician Schedule of Benefits for diagnostic procedures and specialist consultations requested by nurse practitioners and dental surgeons
To: All Physicians, Nurse Practitioners, Hospital-Based Dentists
Category: Physician Services, Registered Nurse with Extended Class, Dentist Services
Written by: Provider Services Branch; Physician and Provider Services Division
Date issued: July 17, 2023
Bulletin Number: 230706
The Ministry of Health (ministry) is making changes to the Ontario Health Insurance Plan (OHIP) Schedule of Benefits for Physician Services (Schedule) to help streamline patient care and support scope of practice expansions.
These changes will enable physician payment for the following:
- Diagnostic procedures, including physician interpretation, ordered by nurse practitioners and oral and maxillofacial surgeons when ordering the diagnostic procedure is within their respective scope of practice, and
- Specialist consultation services requisitioned by hospital-based dentists as required to support insured dental procedures.
New general preamble section
Effective July 1, 2023, information regarding OHIP payment to physicians for diagnostic procedures ordered by persons other than a physician will be in the Schedule in a new section of the General Preamble titled “Diagnostic Procedures Ordered by Persons Other Than Physicians”.
Insured services requested by nurse practitioners and dental surgeons
Effective July 1, 2023, the following services are insured under OHIP:
- Magnetic resonance imaging (MRI) scans ordered by oral and maxillofacial surgeons
- MRIs and computed tomography (CT) scans, as well as x-rays and ultrasounds for any region of the body, when ordered by nurse practitioners
- Specialist consultation services requisitioned by hospital-based dentists when required to support insured dental procedures
Claims submission requirements
The insured services described above should be claimed using existing fee codes in the Schedule and include the OHIP Billing number of the provider referring/ordering the service.
Physicians are asked to hold claims for MRI services ordered by oral and maxillofacial surgeons until August 1, 2023, to allow time for updates to the medical claims payment system.
Consults requested by dentists will continue to reject “V09 – Invalid Referring Number” until additional system changes can be completed.
For consult services rendered on or after July 1, 2023, please flag the claim for manual review and reference this INFOBulletin.
A future INFOBulletin will be published to advise physicians when the system changes are complete and the claims for consults requested by dentists can be submitted for processing without flagging the claim for manual review.
Providers requiring an OHIP Billing number should submit the form Application for OHIP Billing Number for Health Professionals to ProviderRegistration.MOH@ontario.ca.
Nurse Practitioner; NP; Oral and Maxillofacial Surgeon; OMFS; Dentist; Dental Surgeon; Magnetic Resonance Imaging; MRI; Computed Tomography; CT; X-ray; Ultrasound; Diagnostic Tests; Diagnostic Procedures; Scope of Practice; Registered Nurse; Extended Class; RN(EC)
Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.