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Claims submitted with a modality indicator which contain services that are eligible to be provided virtually as well as services not eligible for payment when rendered virtually (those not listed in Appendix J of the Schedule) all on the same service date will have the non-virtual care eligible services approved at $0.00 with new explanatory code ‘B8 - Service Not Eligible for Payment ...
Dec 1, 2022 · If the referring physician agrees that ongoing specialist virtual care is medically necessary due to the complexity, seriousness or obscurity of the case and all other payment rules associated with consultations are met, a new consultation is eligible for payment and the subsequent 24-months of virtual assessments are payable as Comprehensive Virtual Care Services.
Dec 1, 2022 · Virtual Care Services are not eligible for payment (defined in General Preamble) where it is not medically appropriate to provide the specific service without a direct physical encounter. If, during the course of a Virtual Care Service, it becomes apparent that the service cannot be appropriately completed without a direct physical encounter ...
1. Existing Schedule Requirements –will apply to all virtual care services. 2. Appropriateness –virtual care services are not eligible for payment where it is not medically appropriate to provide the services without a direct physical encounter. 3. Video Services –must be performed using a Verified Virtual Visit Solution. 4.
the virtual care technologies that best meet the needs of their patients and practices (e.g. technologies other than those currently offered by OTN). 2.2 Virtual Care Program To be eligible to submit claims, Ontario physicians and dentists 3 must submit a registration form 4 and register with the ministry for virtual care billing privileges.
Dec 1, 2022 · However, it is not intended to replace existing Schedule fee codes that were in place prior to March 2020 for services that were eligible for payment if provided virtually. Insured physician services that can be provided virtually can be found in Appendix J of the Schedule of Benefits (the Schedule) and are also listed at the end of this EPC Billing Brief.
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Are virtual care services eligible for payment?
Can a physician Bill for virtual care services?
What is a comprehensive virtual care service?
Are limited virtual care services billed?
Will a virtual CARE code replace a schedule fee code?
What is the new section for virtual care services?
The described service is a Comprehensive Virtual Care Service as it is a Specialist Video Consultation and could be claimed as A025A (with the K300A modality indicator) provided that the Schedule specifications for consultations have been met. Source: Virtual Care 1: Comprehensive and Limited Virtual Care Services.
