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New Temporary OHIP Fee Codes - FAQ

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Answers to Common COVID-19 OHIP Billing Codes Questions

What are the new temporary codes?

OHIP has released a temporary list of fee codes that cover assessments of, or counselling to, insured patients by telephone or video, as well as advice and information to a patient’s family member/legal representative.

Our guide to the temporary COVID-19 OHIP billing codes includes specifics about the codes and how to bill both insured and uninsured patients. It also includes contact information should you have additional questions.

I billed the new temporary codes but they got rejected. Why is that? When can I submit these codes?

Effective May 1, 2020, the following temporary codes can be submitted:

  • K080A, K081A, K082A, K083A and H409A for services provided on or after March 14, 2020
  • Sessional Fee Schedule Code H410A for services provided on or after March 21, 2020 

Please resubmit your rejected claims for the above codes and the MoH will process them. 

What diagnostic code should I use for treating COVID-19 patients?

Effective March 14, 2020, a new diagnostic code has been created for the COVID-19 outbreak.

Diagnostic code: 080

Description: Coronavirus

This diagnostic code should be used when the primary purpose for rendering the service for which the claim is being submitted is because the patient is suspected to have or has been diagnosed with COVID-19.

I can’t find the new codes or the fee values of K080/1/2 are outdated in the mobile app.

You will need to update the mobile app as follows:

Please navigate to the left menu -> Preferences -> Refresh App Data -> Update. You should then be able to see the new codes/values when creating a new claim.

Refresh MDBilling app to see new COVID-19 OHIP billing codes
  

How to bill K083? 

K083 would be billed in place of the applicable in-person visit fee for telephone and video visits. According to OHIP Bulletin #4745, the quantity for K083 = listed fee of the services provided in the SoB, rounded to the nearest $5, divided by 5.

The below table provides an example (for Internal Medicine specialty):

Code

Description

Fee

K083 Units

K083 Fee

A135

Consultation

$157.00

31.00

$155.00

A435

Limited consultation

$105.25

21.00

$105.00

A136

Repeat consultation

$105.25

21.00

$105.00

A133

Medical specific assessment

$79.85

16.00

$80.00

A134

Medical specific re-assessment

$61.25

12.00

$60.00

A131

Complex medical specific re-assessment

$70.90

14.00

$70.00

A138

Partial assessment

$38.05

8.00

$40.00


How do I bill H409 / H410 without patient info
?

To submit H409 / H410 codes in our system, you are able to create a dummy patient for codes that are not patient-specific.

  1. Create a dummy patient with the health card value of 9777777779 (with any name and DOB)
  2. Create a new claim with this patient
  3. When the claim is ready to be submitted to the Ministry, we will exclude the patient details entered.

Assessment Centre group number:

On the web:

please go to Settings (under <Welcome>) ->My MOH Group -> Create a group with the Assessment Centre group number -> Add New (please disregard the MOH Group Designation popup message). You will then be able to select the group number when creating a new claim. 

On the mobile app:

Under the left menu -> Preferences -> MOH Groups -> Create -> Enter group number -> submit. The group number will be selectable when creating a new claim.

NOTE: Please ensure this group number is NOT selected when billing Non-Sessional Fee Schedule Codes (H409, H410).

Please refer to the OHIP Bulletin #4755 for more details about the billing rules.

I provided Virtual Care services via OTN. How do I add 'Service Location Indicator' to the claim?

Please follow these instructions: How to Select The Service Location Indicator (SLI).

Important notes regarding submission of virtual care claims:

All physician claims for video visits must include:
a) the appropriate OHIP Schedule of Benefits fee codes for the clinical care provided15;
b) the appropriate Virtual Care Program B-code (i.e. B103A or B203A); and
c) the SLI set to “OTN” to indicate that a consult was done as a video visit.

All dentist claims for video visit must include:
a) at least one of the allowable dental “T” fee codes (i.e. T650, T651, T652, T811,
T812, T813);
b) the appropriate Virtual Care Program B-code (i.e. B103A);
c) the facility number of the approved OTN video solution location where the dentist was located when the service was rendered; and
d) the SLI set to “OTN” to indicate that a consult was done as a video visit.

  • physicians must be registered to bill OTN codes (Physicians submitting OTN billings must have completed and signed the Registration Form on the date of the OTN service in order to bill OHIP) - copy of form attached;

In order to submit the Virtual Care Program B-code, Physicians/Dentists must sign and complete an OHIP Virtual Care Physician & Dentist Registration Form to be registered as a virtual care provider
with the Ministry.

For more information about billing virtual care services via OTN, please see Virtual Care Billing Information Manual.

For billing related inquiries, please contact the Service Support Contact Centre at 1-800-262-6524 or For specific questions about conducting video visits, please contact info@otn.ca.

 

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