GENERAL, HEALTH INSURANCE ACT

O. Reg. 291/17: GENERAL, HEALTH INSURANCE ACT

ontario regulation 291/17

made under the

Health Insurance Act

Made: July 26, 2017
Filed: July 28, 2017
Published on e-Laws: July 28, 2017
Printed in The Ontario Gazette: August 12, 2017

Amending Reg. 552 of R.R.O. 1990

(GENERAL)

1. (1) Subsection 28.2 (1) of Regulation 552 of the Revised Regulations of Ontario, 1990 is amended by striking out “the Table to this section” in the portion before clause (a) and substituting “subsection (3)”.

(2) Subsection 28.2 (3) of the Regulation is revoked and the following substituted:

(3) The following are the amounts payable by the Plan for insured services prescribed in subsection (1):

1. $50 for services that include Magnetic Resonance Imaging (one scan) prescribed by a physician.

2. $210 for services that include renal dialysis.

3. $50 for services that include cancer chemotherapy prescribed by a physician.

4. $50 for services that support a surgical procedure that is ordinarily rendered in an operating room and ordinarily requires the services of an anaesthetist.

5. $50 for services that include a Computerized Axial Tomography scan prescribed by a physician.

6. $50 for services that include either lithotripsy or Magnetic Resonance Imaging (more than one scan), prescribed by a physician.

7. $50 for services not otherwise described in this section that are rendered,

(i) in a hospital, or

(ii) in a health facility, if the services are necessary for the provision of a service that is set out in the schedule of benefits and preceded in the schedule by the symbol “#”.

(3) Subsection 28.2 (4) of the Regulation is amended by striking out “in the Table” and substituting “set out in subsection (3)”.

(4) Section 28.2 of the Regulation is amended by adding the following subsection:

(4.1) If a day’s services are described by more than one paragraph in subsection (3), the highest amount listed in those paragraphs is the amount payable for the services.

(5) The Table to section 28.2 of the Regulation is revoked.

2. Schedule 16 of the Regulation is revoked and the following substituted:

Schedule 16
Schedule of Benefits for out of province services nuclear medicine — in vivo

Nuclear Medicine – In Vivo

Cardiovascular System

Code	Insured service	Fee payable
J802/J602	Venography — peripheral and superior vena cava	91.70
J804/J604	First transit without blood pool images	15.30
J867/J667	First transit with blood pool images	54.60
J806/J606	Cardioangiography — first pass for shunt detection, cardiac output and transit studies	90.60
J807/J607	Myocardial perfusion scintigraphy — immediate post stress, resting	207.30
J808/J608	Myocardial perfusion scintigraphy — delayed	76.40
J810/J610	Myocardial scintigraphy — acute infarction, injury	84.00
J811/J611	Myocardial wall motion studies	90.60
J812/J612	Myocardial wall motion studies — repeat same day (maximum of three repeats)	45.80
J813/J613	Myocardial wall motion studies with ejection fraction	128.80
J814/J614	Myocardial wall motion studies with ejection fraction — repeat same day (maximum of three repeats)	45.80
J815/J615	Detection of venous thrombosis using radioiodinated fibrinogen up to ten days	125.50

Endocrine System

Code	Insured service	Fee payable
J816/J616	Adrenal scintigraphy with idocholesterol	367.75
J868/J668	Adrenal scintigraphy with idocholesterol and dexamethasone suppression	431.05
J869/J669	Adrenal scintigraphy with MIBG	529.05
J817/J617	Thyroid uptake	27.30
J870/J670	Thyroid uptake — repeat	14.20
J818/J618	Thyroid scintigraphy with Tc99m or I-131	61.10
J871/J671	Thyroid scintigraphy with I-123	98.20
J820/J620	Parathyroid scintigraphy — dual isotope technique with T1201 and Tc99m Iodine	224.80
J872/J672	Metastatic survey with I-131	229.10

Gastrointestinal System

Code	Insured service	Fee payable
J821/J621	Schilling test — single isotope	42.60
J823/J623	Schilling test — dual isotope	45.80
J824/J624	Malabsorption test with C14 substrate	54.60
J873/J673	Malabsorption test with whole body counting	131.00
J825/J625	Gastrointestinal protein loss	78.50
J874/J674	Gastrointestinal blood loss — Cr51	58.90
J826/J626	Calcium absorption — Ca45	58.90
J875/J675	Calcium47 absorption/excretion	241.15
J827/J627	Esophageal motility studies — one or more	114.60
J829/J629	Gastrointestinal transit	98.20
J876/J676	Gastrointestinal reflux	54.60
J877/J677	Gastroestophageal aspiration	38.20
J830/J630	Abdominal scintigraphy for gastrointestinal bleed — Tc99m sulphur colloid or Tc04	82.90
J878/J678	Abdominal scintigraphy for gastrointestinal bleed — labeled RBCs	136.40
J879/J679	Abdominal scintigraphy for gastrointestinal bleed — Le Veen shunt patency	63.25
J831/J631	Biliary scintigraphy	109.10
J832/J632	Liver/spleen scintigraphy	76.30
J833/J633	Salivary gland scintigraphy	91.65

Genitourinary System

Code	Insured service	Fee payable
J834/J634	Dynamic renal imaging	91.65
J835/J635	Computer assessed renal function (includes first transit)	125.50
J880/J680	Computer assessed renal function (includes first transit) — repeat after pharmacological intervention	43.00
J836/J636	Static renal scintigraphy	30.50
J837/J637	ERPF by blood sample method	38.20
J838/J638	GFR by blood sample method	38.20
J839/J639	Cystography for vesicoureteric reflux	114.80
J840/J640	Testicular and scrotal scintigraphy (includes first transit)	78.50

Hematopoietic System

Code	Insured service	Fee payable
J841/J641	Plasma volume	41.45
J843/J643	Red cell volume	45.80
J847/J647	Ferrokinetics — clearance, turnover, and utilization	381.90
J848/J648	Red cell, white cell or platelet survival	98.20
J849/J649	Red cell, survival with serial surface counts	141.90
J881/J681	Bone marrow scintigraphy — whole body	109.10
J882/J682	Bone marrow scintigraphy — single site	80.80
J883/J683	In-111 leukocyte scintigraphy — whole body	347.00
J884/J684	In-111 leukocyte scintigraphy — single site	305.60

Musculoskeletal System

Code	Insured service	Fee payable
J850/J650	Bone scintigraphy — general survey	98.80
J851/J651	Bone scintigraphy — single site	80.80
J852/J652	Gallium scintigraphy — general survey	169.20
J853/J653	Gallium scintigraphy — single site	117.85
J854/J654	Bone mineral density by single photon method	29.50
J855/J655	Total body calcium — neutron activation	185.50
J888/J688	Bone mineral content by dual photon absorptiometry — single site	111.90
J856/J656	Bone mineral content by dual photon absorptiometry — two or more sites	146.40

Nervous System

Code	Insured service	Fee payable
J857/J657	CSF circulation with Tc99m or I-131 HSA	114.60
J885/J685	CSF circulation with In-111	294.60
J886/J686	CSF circulation via shunt puncture	85.05
J858/J658	Brain scintigraphy	86.20

Respiratory System

Code	Insured service	Fee payable
J859/J659	Perfusion long scintigraphy	81.80
J887/J687	Ventilation lung scintigraphy	102.60
J860/J660	Perfusion and ventilation scintigraphy — same day	163.70

Miscellaneous

Code	Insured service	Fee payable
J861/J661	Radionuclide lymphangiogram	106.90
J862/J662	Ocular tumour localization	72.00
J864/J664	Tear duct scintigraphy	92.80
J865/J665	Total body counting	179.00
J866/J666	Tomography (SPECT)	41.45

Diagnostic Radiology

Head and Neck

Code	Insured service	Fee payable
X001	Skull — four views	30.65
X009	Skull — five or more views	38.20
X003	Sella turcica (when skull not examined)	15.30
X004	Facial bones — minimum of three views	22.20
X005	Nose — minimum of two views	15.30
X006	Mandible — minimum of three views (uni or bilateral)	22.20
X012	Mandible — four or more views	30.65
X007	Temporomandibular joints — minimum of four views including open and closed mouth views	22.20
X008	Sinuses — minimum of three views	22.20
X010	Mastoids — bilateral — minimum of six views	29.40
X011	Internal auditory meati (when skull not examined)	22.20
X016	Eye, for foreign body	15.20
X017	Eye, for localization, additional	15.60
X018	Optic foramina	17.20
X019	Salivary gland region	14.10
X020	Neck for soft tissues — minimum of two views	14.10

Spine and Pelvis

Code	Insured service	Fee payable
X025	Cervical spine — two or three views	26.50
X202	Cervical spine — four or five views	34.20
X203	Cervical spine — six or more views	41.40
X027	Thoracic spine — two views	24.30
X204	Thoracic spine — three or more views	31.90
X028	Lumbar or lumbrosacral spine — two or three views	26.50
X205	Lumbar or lumbrosacral spine — four or five views	34.20
X206	Lumbar or lumbrosacral spine — six or more views	41.50
X032	Entire spine — (scoliosis series) minimum of four views	54.95
X033	Entire spine — Orthoroentgenogram (3 foot film) — single view	22.20
X031	Entire spine — Orthoroentgenogram (3 foot film) — two or more views	30.60
X034	Sacrum and/or coccyx — two views	25.60
X207	Sacrum and/or coccyx — three or more views	31.90
X035	Sacro-iliac joints — two or three views	22.20
X208	Sacro-iliac joints — four or more views	29.70
X036	Pelvis and/or hip(s) — one view	15.30
X037	Pelvis and/or hip(s) — two views (e.g. A.P. and frog view, both hips; or A.P. both hips plus lateral one hip)	28.50
X038	Pelvis and/or hip(s) — three or more views (e.g. pelvis and sacro-iliac joints, or A.P. both hips plus lateral each hip)	32.70

Upper Extremities

Code	Insured service	Fee payable
X045	Clavicle — two views	15.30
X209	Clavicle — three or more views	23.50
X046	Acromioclavicular joints (bilateral) with or without weighted distraction — two views	22.20
X210	Acromioclavicular joints (bilateral) with or without weighted distraction — three or more views	30.40
X047	Sternoclavicular joints — (bilateral) — two or three views	18.30
X211	Sternoclavicular joints — (bilateral) — four or more views	26.40
X048	Shoulder — two views	18.30
X212	Shoulder — three or more views	26.40
X049	Scapula — two views	18.30
X213	Scapula — three or more views	26.40
X050	Humerus — including one joint — two views	15.30
X214	Humerus — three or more views	23.50
X051	Elbow — two views	15.30
X215	Elbow — three or four views	23.50
X216	Elbow — five or more views	31.60
X052	Forearm — including one joint — two views	15.30
X217	Forearm — including one joint — three or more views	23.50
X053	Wrist — two or three views	15.30
X218	Wrist — four or more views	23.50
X054	Hand — two or three views	15.30
X219	Hand — four or more views	23.50
X055	Wrist and hand — two or three views	22.20
X220	Wrist and hand — four or more views	28.35
X056	Finger or thumb — two views	11.80
X221	Finger or thumb — three or more views	15.30

Lower Extremities

Code	Insured service	Fee payable
X060	Hip — (unilateral) — two or more views	24.30
X063	Femur, including one joint — two views	15.30
X223	Femur, including one joint — three or more views	23.50
X065	Knee (including patella) — two views	15.30
X224	Knee (including patella) — three or four views	23.50
X225	Knee (including patella) — five or more views	31.60
X066	Tibia and fibula (including one joint) — two views	15.30
X226	Tibia and fibula (including one joint) — three or more views	23.50
X067	Ankle — two or three views	15.30
X227	Ankle — four or more views	23.50
X068	Calcaneus — two views	15.30
X228	Calcaneus — three or more views	23.50
X069	Foot — two or three views	15.30
X229	Foot — four or more views	23.50
X072	Toe — two views	11.80
X230	Toe — three or more views	15.30
X064	Leg length studies (orthoroentgenogram)	22.20

Skeletal Surveys

Code	Insured service	Fee payable
X057	Skeletal survey for bone age — single film	15.30
X058	Skeletal survey for bone age — two or more films or views	22.40
X080	Other survey studies — e.g., rheumatoid, metabolic or metastic — basic	7.60
X081	Other survey studies — e.g., rheumatoid, metabolic or metastic — plus per film or view	7.60

Chest

Code	Insured service	Fee payable
X090	Single film	15.30
X091	Two views	22.50
X092	Three or more views	28.90
X039	Ribs — two or more views	18.30
X040	Sternum — two or more views	18.30
X096	Thoracic inlet — two or more views	15.30

Abdomen

Code	Insured service	Fee payable
X100	Single view	15.30
X101	Two or more views	23.40

G.I. Tract

Code	Insured service	Fee payable
X105	Palatopharyngeal analysis (cine or videotape)	30.20
X106	Pharynx and oesophagus (cine or videotape)	30.20
X107	Oesophagus — when X103, X104, X108 or X109 not billed	27.40
X108	Oesophagus, stomach and duodenum — including survey film if taken	47.50
X104	Oesophagus, stomach and duodenum — double contrast, including survey film if taken	49.40
X103	Oesophagus, stomach and duodenum — double contrast, including survey film if taken, and small bowel	62.50
X109	Oesophagus, stomach and small bowel	60.55
X110	Hypotonic duodenogram	40.40
X111	Small bowel only — when only examination performed during patient’s visit	27.40
X112	Colon — barium enema (including survey film, if taken)	49.50
X113	Colon — air contrast, primary or secondary, including survey films, if taken	62.60
X114	Gallbladder (one or multiple day examinations)	30.65
X120	Gallbladder (one or multiple day examinations with preliminary plain film	40.80
X116	T-tube cholangiogram	22.20
X117	Operative cholangiogram	22.20
X118	Intravenous cholangiogram	50.70
X123	Operative pancreatogram or E.R.C.P.	22.20

G.U. Tract

Code	Insured service	Fee payable
X129	Retrograde pyelogram, unilateral or bilateral	22.20
X130	Intravenous pyelogram including preliminary film	50.80
X137	Cystogram (catheter)	24.40
X135	Cystourethrogram, stress or voiding (catheter)	28.30
X131	Cystourethrogram (non-catheter)	5.95
X191	Intestinal conduit examination or nephrostogram	22.20
X138	Percutaneous antegrade pyelogram	22.20
X139	Percutaneous nephrostogram	22.20
X134	Urethrogram (retrograde)	18.30
X136	Vasogram	18.30

Obstetrics and Gynaecology

Code	Insured service	Fee payable
X143	Survey film	15.30
X144	Pelvimetry	22.20
X147	Hysterosalpingogram	30.60
X148	Intra-uterine foetal transfusion — radiological control	40.40

Fluoroscopy — by Physician With or Without Spot Films

Code	Insured service	Fee payable
X195	Chest	9.50
X196	Skeleton	9.50
X197	Abdomen	9.50
X189	Fluoroscopic control of clinical procedures done by another physician per 1/4 hour	7.50

Special Examinations

Code	Insured service	Fee payable
X155	Abdominal or pelvic pneumogram	41.00
X179	Angiography — by catheterization — abdominal, thoracic, cervical, or cranial — using single films — non-selective	30.60
X180	Angiography — by catheterization — abdominal, thoracic, cervical, or cranial — using single films — selective (per vessel to max. of 4)	40.40
X181	Angiography — by catheterization — abdominal, thoracic, cervical, or cranial — using film changer, cine or multiformat camera — non-selective	61.15
X182	Angiography — by catheterization — abdominal, thoracic, cervical, or cranial — using film changer, cine or multiformat camera — selective (per vessel to a max. of 4)	81.40
X140	Angiography — by catheterization — abdominal, thoracic, cervical, or cranial — using film changer, cine or multiformat camera — selective (5 or more vessels)	325.60
X160	Carotid angiogram — direct puncture — unilateral	50.15
X161	Carotid angiogram — direct puncture — bilateral	80.60
X174	Peripheral angiogram — unilateral	30.60
X175	Peripheral angiogram — bilateral	40.40
X198	Splenoportogram	60.60
X199	Translumbar aortogram	60.60
X132	Vertebral angiogram — direct puncture or retrograde brachial injection — unilateral	50.15
X133	Vertebral angiogram — direct puncture or retrograde brachial injection — bilateral	82.00
X156	Arthrogram, tenogram, or bursogram	26.90
X200	Arthrogram, tenogram, or bursogram — with fluoroscopy and complete positioning throughout by physician	37.70
X157	Bone density (mineral content) measurement	34.30
X158	Bronchogram — unilateral	30.10
X159	Bronchogram — bilateral	39.90
X162	Cerebral stereotaxis	61.15
X122	Cholangiogram, percutaneous transhepatic	30.30

Miscellaneous Examinations

Code	Insured service	Fee payable
X151	Cordotomy, percutaneous	50.15
X163	Dacrocystogram	30.60
X164	Discogram(s) — one or more levels	30.10
X167	Fistula or sinus	22.20
X169	Laminogram, planigram, tomogram	41.00
X170	Laryngogram	30.10
X171	Lymphangiogram	50.70
X192	Mammary ductography	22.20
X184	Mammogram — dedicated equipment — unilateral	25.40
X185	Mammogram — dedicated equipment — bilateral	37.80
X186	Mammogram — using xeroradiography — unilateral	31.45
X187	Mammogram — using xeroradiography — bilateral	48.30
X150	Mechanical evaluation of knee	26.20
X193	Microradioscopy of the hands	15.05
X173	Myelogram (spine and/or posterior fossa)	35.90
X190	Pantomography	18.30
X154	Penis	16.40
X176	Sialogram	30.60
X177	Skin thickness measurement	16.10
X183	Ventriculogram	50.15
X166	Examination using portable machine, add to first examination only (may only be claimed one per day regardless of the number of people x‑rayed in the same residence)	64.80

Diagnostic Ultrasound

Head and Neck

Code	Insured service	Fee payable
J122	Brain — complete, B-mode	46.10
J102	Echography — ophthalmic (excluding vascular study) — quantitative, A-mode	21.80
J103	Echography — ophthalmic (excluding vascular study) — B-scan immersion	42.90
J107	Echography — ophthalmic (excluding vascular study) — B-scan contact	21.70
J108	Echography — ophthalmic (excluding vascular study) — Biometry (Axial length — A-mode)	22.20
J105	Face and/or neck (excluding vascular study)	46.20
J106	Paranasal sinuses, A-mode	6.35

Heart — Echocardiography

(see listings in Diagnostic and Therapeutic Procedures in the Schedule of Benefits)

Thorax

Code	Insured service	Fee payable
J125	Chest masses, pleural effusion — A & B-mode	47.60

Abdomen and Retroperitoneum

Code	Insured service	Fee payable
J135	Abdominal scan, complete	47.60
J128	Abdominal scan, limited study (e.g. gallbladder only, aorta only or follow-up study)	31.40

Pelvis

Code	Insured service	Fee payable
J159	Pregnancy, complete	47.60
J162	Pelvic, complete	47.60
J163	Pelvis or pregnancy, limited study (e.g. foetal age determination, placental localization, I.U.C.D. localization)	31.40
J138	Intracavity ultrasound (e.g. transrectal, transvaginal)	47.60

Vascular System

Code	Insured service	Fee payable
J190	Extra-cranial vessel assessment (bilateral carotid and/or subclavian and/or vertebral arteries) — Doppler scan or B scan	41.70
J191	Extra-cranial vessel assessment (bilateral carotid and/or subclavian and/or vertebral arteries) — frequency analysis	41.70
J192	Extra-cranial vessel assessment (bilateral carotid and/or subclavian and/or vertebral arteries) — frequency analysis with Doppler scan	52.40
J201	Extra-cranial vessel assessment (bilateral carotid and/or subclavian and/or vertebral arteries) — Duplex scan i.e. simultaneous real time, B mode imaging and spectral analysis	64.60
J193	Peripheral artery and/or vein evaluation — Doppler scan or B scan, unilateral	21.60
J194	Peripheral artery and/or vein evaluation — frequency analysis, unilateral	14.40
J195	Peripheral artery and/or vein evaluation — frequency analysis with Doppler scan, unilateral	27.10
J202	Peripheral artery and/or vein evaluation — Duplex scan i.e. simultaneous real time, B-mode imaging and spectral analysis, unilateral	32.40
J198	Venous assessment (bilateral — includes assessment of femoral, popliteal and posterior or tibial veins with appropriate functional manoeuvres and permanent record)	7.20
J205	Doppler evaluation of organ transplantation — arterial and/or venous	21.60

Vascular Laboratory Fees

Code	Insured service	Fee payable
J200	Ankle pressure measurements with segmental pressure recordings and/or pulse volume recordings and/or Doppler recordings	19.90
J196	Ankle pressure measurements with exercise and/or quantitative measurements added to the above	7.80
J197	Penile pressure recordings — two or more pressures	6.75
J203	Transcutaneous tissue oxygen tension measurements	23.50
J204	Transcutaneous tissue oxygen tension measurements — when done in addition to Doppler studies	12.90

Miscellaneous

Code	Insured service	Fee payable
J180	Echography for placement of radiation therapy fields, scan B-mode	34.30
J182	Extremities — per limb (excluding vascular study)	23.10
J127	Breast — scan B-mode (per breast)	23.10
J183	Scrotal scan	46.20
J149	Ultrasonic guidance of biopsy, aspiration, amniocentesis or drainage procedures (one physician only)	46.20

Pulmonary Function Studies

Code	Insured service	Fee payable
J311	Functional residual capacity by gas dilution method	16.00
J307	Functional residual capacity by body plethysmography	17.30
J305	Lung compliance (pressure volume curve of the lung from TLC to FRC)	51.30
J306	Airways resistance by plethysmography or estimated using esophageal catheter	15.90
J340	Maximum inspiratory and expiratory pressures	2.70
J309	Carbon monoxide diffusing capacity by steady state at rest	10.60
J310	Carbon monoxide diffusing capacity by single breath method	21.20
J308	Carbon dioxide ventilatory response	19.70
J328	Oxygen ventilatory response (physician must be present)	19.70
J315	Stage I: Graded exercise to maximum tolerance (exercise must include continuous heart rate, oximetry and ventilation at rest and at each workload)	61.70
E450	J315 plus J301 or J304 before and/or after exercise, add	13.10
E451	J315 plus 12 lead E.C.G. done at rest, used for monitoring during the exercise and followed for at least 5 minutes post exercise, add	17.90
J316	Stage II: Repeated steady state graded exercise (must include heart rate, ventilation, VO2, VCO2, BP, ECG, end tidal and mixed venous CO2 at rest, 3 levels of exercise and recovery	88.95
J317	Stage III: J316 plus arterial blood gases, pH and bicarbonate or lactate	171.50
J330	Assessment of exercise induced asthma (workload sufficient to achieve heart rate 85% of predicted maximum; performance of J301 or J304 before exercise and 5-10 minutes post exercise)	32.90
J319	Blood gas analysis: pH, PO2, PCO2, bicarbonate and base excess	11.10
J318	Arterialized venous blood sample collection (e.g. ear lobe)	3.70
J320	A-a oxygen gradient requiring measurement of RQ by sampling mixed expired gas and using alveolar air equation	27.20
J331	Estimate of shunt (Qs/Qt) breathing pure oxygen	27.20
J313	Mixed venous PCO2, by the rebreathing method	11.10
J323	O2 saturation by oximetry at rest, with or without O2	4.20
J332	Oxygen saturation by oximetry at rest and exercise, or during sleep with or without O2	17.40
J334	J332 with at least two levels of supplemental O2	30.25
J322	Standard O2 consumption and CO2 production	5.20
J333	Non-specific bronchial provocative test (histamine, methylcholine, thermal challenge)	47.65
J335	Antigen challenge test	51.20
J341	Trans diaphragmatic pressure measurement	51.30

Commencement

3. This Regulation comes into force on the day it is filed.