General Assessments A001 Minor Assessment $23.75 A007 Intermediate Assessment $36.85 A003 $84.45 A005 GP Consultation $84.45 General Assessment A888 ED Equivalent $36.85 K030 DM Management (max 4x/yr) $40.55 K037 $67.75 Fibromyalgia/Chronic Fatigue - need referring MD - Sat/Sun/Hol/Dec 25 - 31; all visits need A888 that day - Add Q012 - add Q040 1/year (need 3xK030) $60/year - for any visit, regardless of reason K032 Neurocog Assessment $67.75 - MoCA only, MD only K022 $67.75 HIV Primary Care K023 $72.15 Palliative Care/Home Visit Periodic Health Exam K017 Child (2-15) $43.60 K130 Adolescent (16-17) $77.20 K131 $54.00 Adult (18-64 inclusive) No diagnostic code necessary K132 $77.20 Adult (65 and older) Counselling K005 Primary Mental Health Care $67.75 K007 Psychotherapy $67.75 K013 $67.75 Educational Counselling E079 Initial Visit (1 per 12 months) $15.55 K039 $33.45 Follow-up visit (2/ 12 months) - Bill with A/K codes; use flowsheet - Bill with A/K codes; use flow sheet Q042 $7.50 Counselling Fee K002 $67.75 Interview with Family K028 $67.75 STD Counselling A680 $144.75 Substance Use Consult K680 $67.75 Substance Use Follow-up - Bill with K039, subsequent to E079 G590 Q590 Flu sole reason (FHO) G538 Flu shot Other: Hep A, Twinrix, MMRV, Men B, Pneumovax, Tdap-IPV, Td, Zostavax G840 DTaP-IPV (Quadracel) G841 DTaP-IPV-Hib (Pediacel) G842 Hep B (Engerix) G843 HPV G844 Men C (Menjugate) G845 MMR (Priorix) G846 Prevnar-13 G847 Tdap (Adacel, Boostrix) G848 Varicella (Varivax) Preventative Tracking Codes Q150 FIT Counselling $7.00 Colon CA Q133/Q142 Tracking/exclusion (50-74) Mammogram Q131/Q141 Tracking/exclusion (50-74) Pap Screens G365 + E430 Pap (every 33 months, 21 - 69) $8.65 + $11.95 G394 + E431 If previous abnormal Q011/Q140 Tracking/exclusion (21-69) + Q015 <12 mo (max 8) $13.99 A002 18 Month Visit (17-24mo) - need WBV, Rourke, Nipissing $62.20 G202 Allergy Inj (max 2) $4.45 G212 Allergy Inj, sole - add G202 x1 if > 1 inj $9.75 G372 Inj (IM, SC, ID) w/ visit $3.89 G373 Inj (sole reason), first $6.75 - add G372 for each additional inj G370 Joint, Bursa, Ganglion $20.25 G371 Subsequent Inj (max 5) $19.90 G328 Aspiration +/- inj $39.80 add G329 additional joint (max 2) $20.25 Perinatal Care P005 Antenatal Assessment $45.15 P003 Full Hx + Exam (1/ preg) $77.20 - bill once with either P004/P003 - P codes not eligible with Q012 after hours Office Procedures E542 Tray Fee (#) $11.55 Z117 $11.65 Bill in addition to A/K codes + G700 if sole reason Cryotherapy + Z119 $29.00 LN2 to 5 or more AK + Dx code = 232, only for plantar, perianal, genital warts, all warts if immunocomp, warts, HEENT warts < 18 yo Z770 $34.05 Endometrial Bx G378 $31.10 IUD Insertion G420 $11.35 Ear syringe/curette + G403 $5.70 $21.15 Epley G014 Rapid Strep Swab Z101 $25.75 I&D Abscess/Hematoma Z106 $44.35 I&D Pilonidal Abscess Z113 $29.60 Skin Bx (no sutures) Z116 $29.60 Skin Bx (suture) Z114 $25.25 FB Removal w/ local Pre-Malignant Malignant Face/Neck Other R160 $53.20 R161 $87.40 R162 $174.75 R163 $43.60 R164 $71.80 R165 $143.55 1 2 ≥ 3 R048 $92.15 R049 $139.20 R050 $233.00 R094 $58.15 R040 $95.70 R041 $191.40 1 2 ≥ 3 Face/Neck Other Z104 $20.10 I&D Perianal Z173 2 Abscess ($30.85); Z174 ≥ 3 ($40.80) Forms K035 MTO Mandatory $36.25 K623 Form 1 + 42 $113.35 K034 $36.00 Reportable Dz K070 $31.75 CCAC/Home Care K038 $45.15 LTC Application Q020 Bipolar Q021 Schizophrenia need min 5-9 pts = $1000 10+ pts = $2000 Bill all Q020/Q021 April 1st. Other Q012 After Hours Premium 30% E080 1st visit <14d post d/c $25.25 K730 Call consultant (>10min) K734 Call ED doc (>10min) K738 e-consult Dan Cojocaru, MD December 2022 K055 $20.70 Special Diet Z128 $33.10 Nail Resection Q050 $125 Heart Failure Incentive Fee - once yearly; eligible with Q012 K036 $10.25 Northern Travel Grant G271 INR (monthly) $12.75 G010 $2.14 Urinalysis # A920 $161.15 Early Preg Medical Mgmt A900 $45.15 Complex Elderly/Homebound Travel Premium First Patient Seen Premium B960 B990 $36.40 $27.50 Home Visits + Palliative Visits Palliative Travel Premium First Patient Seen Premium B966 B998 $36.40 $82.50 Q888 $36.85 UCC Sat/Sun/Holiday Chronic Illness Codes G005 Pregnancy Test $3.88 K029 Insulin Therapy Support $67.75 + # + G700 (sole) # E542 (tray fee) Time-based + P008 $36.85 Post-natal Care Office P004 $36.85 Routine Prenatal Visit # # # # # # # # K071 $21.40 Acute Homecare Supervision K072 Chronic Homecare Supervision - two per patient/year. In-person. Influenza Q130 Tracking code (> 64 yo) Rostering Codes Q200 Q053 HCC Complex FHO Rostering Virtual Care K300 Video K301 Telephone - 50 min assessment $21.40 K033 $67.75 Use if already billed 3 K013)/yr + G375 ≥3 Lesion steroid inj Smoking Cessation (MRP only) Serious Mental Illness Inections (allergy, joint, bursa) $350 A101 Limited Video A102 Limited Telephone $20.00 $15.00 Legend Ontario Family Medicine Billing Guide $31.35 $31.35 $16.00 K050 MCFSC HSR & ADL Form $103.55 K051 Health Status Report (HSR) $82.85 K052 ADL Form $20.70 K053 $15.55 OW Form K054 $25.90 Special Necessities Form K056 $20.70 Pregnancy Allowance Q043 Abnormal Risk CRC $150-$230 Q023 From Hospital $150 Q401 -- Q402 -- Q403 De-Rostering Vaccines/Injections Out-of-basket $8.85 Minor Assessment $8.65 + $11.95 K005 - you can bill an A001 or A007 with a K005 mental health visit if they have separate complaints in addition to their mental health (i.e. cough and depression). Document start/stop time for both issues. Consider submitting for manual review. You cannot bill A007 + K013 on same day. K301 - Telephone visits are paid at 85% of corresponding in-person fee except for mental health visits K007, K005 (paid at 95%) K029 (Insulin Therapy Support) - Counselling for patients requiring insulin injections 3x/day or infusion pump. Includes training for patients on insulin who use devices such as glucose meters, insulin pumps and insulin pens when rendered by the physician claiming K029. Out of basket. K034 (Reportable Disease) - K034 is only eligible for payment for the following specified reportable diseases: anthrax, botulism, brucellosis, cholera, cryptosporidiosis, cyclosporiasis, diphtheria, primary viral encephalitis, food poisoning (all causes), symptomatic giardiasis, invasive haemophilus influenzae b disease, hantavirus pulmonary syndrome, hemorrhagic fevers (e.g. ebola, marburg and other viral causes), hepatitis A, lassa fever, legionellosis, listeriosis, measles, acute bacterial meningitis, invasive meningococcal disease, paratyphoid fever, plague, acute poliomyelitis, Q fever, rabies, rubella, Severe Acute Respiratory Syndrome (SARS), shigellosis, smallpox, invasive group A streptococcal infections, tularemia, typhoid fever, verotoxin-producing E. coli infection indicator conditions (e.g. haemolytic-uremic syndrome), west Nile virus illness, and yellow fever. K071/K072 - K071 is a service rendered by a physician for personally providing medical advice, direction or information to health care staff of a CCAC or CCAC contractor on behalf of a patient for whom the physician provides on-going medical care (first 8 weeks following admission to home care program). The K072 is the same as K071 but applies to after the 8th week following admission to home care program. E080 (video only), E079, Q050, K030 - can be billed with K300/K301 virtual consults. E080 rules: no day Sx, no OB/neonate unless ICU/NICU, (in-person/video only) Q012/Q016 Codes Apply To: A001, A003, K017, K130, K131, K132, A004, A007, A008, A888, Q888, K005, K013, K030, K033, Q050. Prenatal Billing - P005 is billed at the first prenatal visit only, also known as the antenatal preventative assessment, require to complete Ontario Perinatal Record. P004 is a minor prenatal assessment (think of it as an A007 equivalent). P003 is a general prenatal assessment (think of it as an A003 equivalent). P008 may be billed up to 12 months post-partum, for postpatrum issues only (e.g. bleeding, cramping, breast feeding, mood). All out-of-basket. A920 (Medical Management of Early Pregnancy) - Billed when physician renders an initial assessment and administers or gives a cytotoxic medication for early pregnancy termination or missed abortion. You cannot bill another code for this patient (i.e. cannot bill A007 for assessment or K013 for counselling in addition to A920). Medical Form Codes (e.g. K035) do not need to be billed on the same day that you saw the patient or complete the form. They can be billed on any day. Access bonus is 18.95% of your billings each month. Any patient seen outside your group are deducted dollar for dollar. Home/Palliative Visit Rules - frail elderly patient, housebound patient, or palliative (document in chart). Bill with Travel + First Person Seen Premium. If you see a certain number of A900/palliative per year, you will receive a bonus payment ranging from $1500-$8000. A frail elderly patient is: - 65 years of age or older and has one or more of the following - complex medical management needs that may include polypharmacy - cognitive impairment (such as dementia or delirium); age-related reduced mobility or falls; or unexplained functional decline (not otherwise described above). A housebound patient is a person: - that has difficulty in accessing office-based primary health care services because of medical, physical, cognitive, or psychosocial needs/conditions; - transportation is not available or not appropriate in the person’s circumstances - other strategies to address the access challenges have been considered but are not available or not appropriate in the person’s circumstances - for whom the care and support requirements can be effectively and appropriately delivered at home. FHN/FHG Differences - After Hours Fee: Q012 (FHG, FHN, FHO); Q016 (CCM) - Episodic Newborn Care: Q015 (FHO); Q015 (FHN) Long-Term Care Special Premium : ≥ 12 patients served = $2000; ≥ 12 patients served = $5000 annual bonus (W010, W102, W002, W008, W121, W003, W001, W107, W777, W903, W004, W104) Prenatal Care Special Premium : ≥ 5 enrolled FHO patients (only) during 1st 28 wks = $2000 ((P003 and/or P004) Home Visits (Other than Palliative Care) Special Premium : ≥3 patients + ≥ 12 encounters = $1500; ≥6 patients + ≥ 24 encounters = $3000; ≥17 patients + ≥ 68 encounters = $5000; ≥32 patients + ≥ 128 encounters = $8000; Palliative Care Special Premium : ≥4 patients $2000; ≥10 patients $5000 (K023, C882, A945, C945, W882, W872, B998) Labour & Delivery Special Premium : ≥5 patients $5000; ≥23 patients $8000 (P006, P007, P009, P018, P020) Additional Notes/FAQ MOH Service Support Contact Centre 1-800-262-6524 SSContactCentre.MOH@ontario.ca Preventative Care Category % Fee Billing Code Influenza Vaccine (patients ≥ 65) 60 $220 Q100A 65 $440 Q101A 70 $770 Q102A 75 $1100 Q103A 80 $2200 Q104A Pap Smear (patients 21-69 yrs inclusive) 60 $220 Q105A 65 $440 Q106A 70 $770 Q107A 75 $1320 Q108A 80 $2200 Q109A Mammography (patients 50-74 yrs inclusive) 55 $220 Q110A 60 $440 Q111A 65 $770 Q112A 70 $1320 Q113A 75 $2200 Q114A Childhood Immunization (30-42 months) 85 $440 Q115A 90 $1100 Q116A 95 $2200 Q117A CRC Screening (patients 50-74 years inclusive) 15 $220 Q118A 20 $440 Q119A 40 $1100 Q120A 50 $2200 Q121A 60 $3300 Q122A 70 $4000 Q123A Notes Time Based Codes Units Time 1 20 min 2 46 min 3 76 min [1 hr 16 min] 4 106 min [1 hr 46 min] 5 136 min [2 hr 16 min]