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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 · Virtual Care Fee Codes that pre-date March 2020 continue to be available for use. The new Virtual Care Services are not intended to replace existing Schedule fee codes for services that were eligible for payment if provided virtually prior to March 2020, such as those listed below (please note, this list is not comprehensive).
Dec 1, 2022 · A psychiatrist, Dr. King, provided a video consultation in November 2022 that established an existing/ongoing relationship with the patient, Mr. Gordon. This service was paid using the K083 fee code. Subsequent video and telephone visits are eligible for payment as comprehensive virtual care services for 24-months after this visit.
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.
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.
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This guidance is targeted specifically to decision-making related to the clinically appropriate use of virtual care modalities (i.e., e-mail, secure messaging, telephone, video) in the delivery of primary care services. The definition of the term “clinically appropriate” is provided later in this document.
