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      • OHIP Physician Fee Schedule Master These files are intended for use with billing software. The Physician Fee Schedule Master below is effective April 1, 2024. If your billing software has not been updated by your vendor, you are encouraged to do so at your earliest convenience.
      www.ontario.ca/page/ohip-schedule-benefits-and-fees
  1. OHIP Physician Fee Schedule Master. These files are intended for use with billing software. The Physician Fee Schedule Master below is effective April 1, 2024. If your billing software has not been updated by your vendor, you are encouraged to do so at your earliest convenience.

  2. Apr 1, 2024 · Please ensure that your billing software is updated by April 8, 2024 to reflect the new temporary fee schedule code values for any services rendered on or after April 1, 2024. The updated Fee Schedule Master can be found on Ontario.ca.

  3. Apr 3, 2023 · Please ensure that your billing software is updated to reflect the new Fee Schedule Code values for any services rendered on or after April 1, 2023. The updated Fee Schedule Master can be found on the Ministry of Health website. This file will be available for download by April 6, 2023.

  4. May 18, 2022 · The Ministry has announced that physicians must ensure that their billing software is updated to reflect the new FSC values for any services rendered on or after April 1, 2022. The updated Fee Schedule Master can be found on the Ministry of Health website.

    • Introduction
    • Common elements
    • Constituent elements
    • Independent operative procedures (IOP)
    • Payment Rule
    • Specific elements
    • 1. Preambles
    • 2. Consultations and visits
    • 3. Specialty Sections
    • 4. Surgical Procedures
    • Out-patient Internal Medicine Consultation
    • How the Schedule works
    • Specific
    • Example: Understanding the differences between different types of assessment

    Glossary of selected terms used in the module Legal and regulatory framework Uninsured services Medical records Organization of the Schedule Fee schedule codes and naming conventions How the Schedule works More information Help us improve our learning modules Objectives Upon completion of this module, the learner should be able to: Describe the pur...

    The components that are included in the payment for all insured physician services. The common elements are listed in the General Preamble.

    Payment for an insured service includes compensation for performing any applicable common and specific elements of the service, as well as the skill, time and responsibility involved in performing the service. All elements taken together are referred to as the constituent elements of a service.

    Payment for surgical procedural codes without a Z prefix include pre/post operative care. (although first and second-day visits and day of discharge visits may be separately claimed by the Most Responsible Physician (MRP)), whereas surgical procedural codes with a Z prefix are independent operative procedures denoted throughout the Schedule as an I...

    A payment rule specifies a condition that must be met for a listed service to be insured. These are variously titled in the Schedule including: payment rule, medical records requirement, note, etc.

    Components that only apply to specific groups of services. The General Preamble lists specific elements that apply to some groups of services (for example assessments). However, specific elements for other groups of services may be listed in the additional preambles throughout the Schedule (for example the Surgical Preamble). Tip: Additional defini...

    The General Preamble is an essential reference for billing questions. It includes general payment rules for all physicians, as well as definitions, required elements for particular services and details about specific categories of services and premiums. The preambles for groups of services at the beginning of certain sections of the Schedule includ...

    This section outlines fee codes and associated payment rules for patient visits. These include all types of consultations and subsequent visits listed by specialty as well as counselling, psychotherapy and interviews. Physicians should select the most appropriate fee code from the section associated with their specialty designation unless they are ...

    The next set of sections lists fee codes related to specific specialties and non-surgical procedures including: Nuclear Medicine Positron Emission Tomography (PET) Radiation Oncology Diagnostic Radiology Clinical Procedures associated with Diagnostic Radiological Examinations Magnetic Resonance Imaging (MRI) Diagnostic Ultrasound Pulmonary Function...

    This section includes a preamble (applicable to all surgical procedures) as well as sub-sections for groupings of surgical procedures (some with their own specific preambles) including: Integumentary System Musculoskeletal System Respiratory System Cardiovascular Haematic and Lymphatic Digestive System Urogenital and Urinary Male Genital Female Gen...

    (Prefix A – Out-patient; first two numbers 13 – Internal Medicine; third number -Consultation) Suffixes*: These have different meanings depending on the type of fee schedule code they are used with. Diagnostic tests B: indicates a technical fee. This provides compensation for the cost of equipment, personnel, supplies as well as performing the proc...

    The Schedule should be applied in its entirety and not based on an individual service description or listing alone. In order to understand a fee code, you must consider all the elements in the Schedule in order, from general listings of characteristics of services to the specific individual fee code requirements. You may also need to consider all f...

    Rules specific to an individual code. Rules applicable to a group of codes. Specific elements of assessment. Common elements of insured services. Maximum (General Preamble) Definition section of General Preamble.

    The Schedule includes three levels of assessment – general, intermediate, and minor assessment (see General Preamble). Patients may present to their physician for an evaluation with a large variety of clinical conditions. The level of assessment that a physician may need to perform is determined by an individual patient’s circumstances. The hierarc...

  5. New Fee Schedule Codes. This table describes new fee codes introduced into the Schedule of Benefits that are eligible for payment in relation to services rendered from April 1, 2023 onward. This document is a general summary provided for information purposes only.

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  7. Staying on top of the OHIP Schedule of Benefits and billing codes, as well as fees for uninsured services, can be time-consuming. To help Ontario physicians, we’ve made it easy to access billing codes, forms, reference guides on best practices and cheat sheets to ensure accurate billing and save you time.

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  3. Small Business Service Software. Quote, Schedule & Get Paid Faster Through the Jobber App. Estimating, invoicing, scheduling, client communications, and CRM — all in one place.

    Core (annual) - Nga $24.00/muaj - View more items
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