Changes to the Schedule of Benefits

Based on recommendations of the Medical Services Payment Committee (MSPC), there are new changes being made to the Schedule of Benefits that become effective June 1, 2011.  There have been multiple changes made, however, of note are the following:

New Emergency Department Ultrasound Fee $19.65

A new ER ultrasound fee is to be introduced into the Schedule of Benefits when rendered for a patient that is clinically suspected of having at least one of the following life-threatening conditions:

Pericardial tamponade;

Cardiac standstill;

Intraperitoneal hemorrhage associated with trauma;

Ruptured abdominal aortic aneurysm; and

Ruptured ectopic pregnancy.

This fee will only be eligible to Emergency Department Physicians (see page GP40 for the definition of an “Emergency Department Physician”) when personally rendered and who meets standards for training and experience.

Pre-Operative Assessment $33.70

A new pre-dental/pre-operative assessment fee (A/C/W904) for specialists is to be introduced.  General and Family Practice, Pediatricians and Emergency Medicine specialists will remain eligible to bill A/C903 pre-dental/ pre-operative general assessment.

Deletion of Group 3 Plantar Verruca (fee codes Z169 – Z170)

Excising a plantar wart is not standard of practice and the appropriate service is layered excision with paring using chemical cautery or liquid nitrogen.  As such, Group 3 plantar verruca fee codes Z169 – Z170 are to be deleted. 

Weight Loss Services

Language is to be added to the Schedule of Benefits clarifying that monitoring effects resulting from calorie restricted weight loss programs are not insured benefits and should not be billed to OHIP. 

Clarification

Clarification of payment rules are to be noted for G489 Venipuncture, G372/G373 Intramuscular, subcutaneous or intradermal injections and G009/ G010 Urinalysis.

Pulmonary Function Tests

Language is to be added to the OHIP Schedule of Benefits clearly defining the service elements and record-keeping requirements of flow volume loop (J304 and J327) to reflect current professional standards (e.g., measurements with a scale on the tracing or graph of at least 5 mm per L per second for flow; and 10 mm per litre for volume and technical component of the study complies with CPSO Clinical Practice Parameters and Facility Standards for Diagnostic Spirometry and Flow Volume Loop Studies).

To see the update from OMA see: https://www.oma.org/Member/News/PresidentUpdates/Pages/PUVol16n23.aspx

Further details will be set out in a forthcoming OHIP Bulletin, which will be posted online.

Specific details of payment rules and medical record requirements will be described in the OHIP Schedule of Benefits and all of the new changes will be reflected on www.ombis.ca within the next few days.