New policy and claims payment rules related to cervical cancer screening have been introduced.

To: All Physicians
Category: Physician Services
Written by: Claims Services Branch; Health Programs and Delivery Division
Date issued: March 3, 2025
Bulletin Number: 250204

The Ministry of Health and Ontario Health have been working together to implement evidence-based enhancements to the Ontario Cancer Screening Program (OCSP).

By increasing regular screening and follow up care for all individuals with a cervix, including women, transmasculine and non-binary individuals, better patient outcomes can be realised.

To implement this enhancement, changes to policy and claims processing have been introduced.

Effective date

The following changes are effective for claims with a service date of March 3, 2025 and beyond.

Policy changes

The following policy changes are effective beginning March 3, 2025:

  1. New tracking codes L734A and L699A have been introduced and should be used for testing under the OCSP effective March 3, 2025. Effective April 3, 2025, existing laboratory codes L713A and L733A will no longer be used for the OCSP.
  2. New descriptions for the following fee codes:
    • G365A – Collection of cervical cancer screening specimen
    • G394A – Additional cervical cancer screening specimen
    • E430A – Cervical cancer screen specimen collected outside hospital
    • E431A – Follow up cervical cancer screen specimen collected outside hospital
    • L699A – Human Papillomavirus testing
    • L734A – Cervicovaginal cellular evaluation/Pap as part of the OCSP

Claims processing changes

The following claims processing changes are effective beginning March 3, 2025:

  1. Age eligibility for G365A and E430A is changed from 21 years old to 25 years old.
  2. G365A and G394A are not eligible for payment with Z730A, Z731A or Z787A by the same provider, for the same patient, on the same date of service.
    1. If G365A or G394A are submitted with Z730A, Z731A, or Z787A, the ineligible service will be paid at $0 with explanatory code 'D7 – Not allowed in addition to other procedure'.
    2. If G365A or G394A is already paid previously, Z730A, Z731A, or Z787A will be reduced by the value of the G365A or G394A with explanatory code ‘DC - Procedure Paid Previously Not Allowed in Addition to this Procedure’.
  3. The new laboratory codes L734A and L699A will be paid at zero dollars with explanatory code ‘LA - Lab service is funded by special lab agreement’ and are used for tracking purposes.

Please see INFOBulletin 250203 for additional details regarding changes to the Schedule of Benefits for Physician Services.

Keywords/Tags

Pap Smear; Cervical Cancer Screening; reporting period; G365A; G394A; E430A; L734A; L699A; L713A; L733A; Z730A; Z731A; Z787A; Physician Payment Committee; Lab codes

Contact information

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