Recent Billing Changes

Effective April 1, 2011 changes were made to the Special Diet Allowance Application Process (K055).  A new code has been added to the Schedule of Benefits (K056) that is payable for completion of Breast-Feeding & Pregnancy Nutritional Allowance.  The changes have been made on our website and the new forms are linked to each description.

Sinus ultrasound codes have been removed from the Schedule of Benefits, effective April 1, 2011, due to a lack of evidence supporting the usefulness.  The affected codes J106 and J406 have been removed from the Schedule of Benefits.

The Out-Of-Country (OCC) Prior Approval Application process has been revised with a significant change.  Previously applications were able to be brought forward by family physicians, the change now requires that applications MUST be supported by a specialist in the field.  OCC Applications that submitted for genetic testing must also be submitted or supported by a geneticist.

Effective March 14, 2011, accredited pharmacists are able to authorize renewals of existing prescriptions (exclusing narcotics and controlled drugs) without further authorization from the prescriber.

The new regulation under the Drug & Pharmacies Act can only be enacted if;

• The physician cannot be contacted;
• The drug is for a chronic or long-term condition; and
• The patient has a stable history with the drug.

The pharmacist must notify the physician within 7 days from when the medication renewal was authorized; and the medication cannot be renewed for any more than 3 months.