New COVID-19 OHIP Billing Codes
Updated: May 4, 2020
The MOH (Ministry of Health) has released new OHIP billing codes pertaining to COVID-19 pandemic response. These temporary OHIP billing codes are effective as of March 14, 2020. You have the option of using any type of video conferencing software for your virtual patient consult such as: Microsoft Teams, Zoom, Cisco's Webex .
You will not be able to bill for OTN premium codes when using the following new billing codes.
April 15th update: Read this CBC article: Ontario doctors may not get paid for telemedicine until July
Updated April 30th 2020:
New Coronavirus Diagnostic Code - 080
MOH now accepts billing codes K080, K081, and K083.
K080 - minor assessment of a patient by telephone or video (less than 10 minutes), or advice or information by telephone or video to a patient’s representative regarding health maintenance, diagnosis, treatment and/or prognosis $23.75
K081 - a. intermediate assessment of a patient by telephone or video, or advice or information by telephone or video to a patient’s representative regarding health maintenance, diagnosis, treatment and/or prognosis, if the service lasts a minimum of 10 minutes; or b. psychotherapy, psychiatric or primary mental health care, counselling or interview conducted by telephone or video, if the service lasts a minimum of 10 minutes $36.85
K082 - psychotherapy, psychiatric or primary mental health care, counselling or interview conducted by telephone or video per unit (unit means half hour or major part thereof) per unit $67.75
K083 - Specialist consultation or visit by telephone or video. Click here for a k083 calculator.
H410 - COVID-19 Sessional Unit. A per one hour code used for COVID-19. Use only on Saturday, Sunday, holidays and afterhours (17:00h to 07:00h) Monday to Friday - $220.00 per hour.
H409 - COVID-19 Sessional Unit per one hour period or major part thereof, Monday to Friday (07:00 to 17:00) - $170.00 per hour
K083 has a unique calculation. The following are the steps to calculate.
1. K083 by taking your normal consult / assessment billing code and round up to the nearest $5 increment.
2. Divide Step 1 by 5 in order to obtain your K083 units.
3. Multiply your K083 units by $5 per unit in order to obtain your total revenue receivable.
Example: A064 - Partial Assessment with a normal payout of: $24.05.
1. $24.05 rounded up to $25.00 (if fee were $22.00, you would round down to $20)
2. $25.00 / 5 = 5 K083 units
3. 5 K083 units * $5 per unit = $25.00 MOH payout.
Click here for a K083 calculator.
MOH Notes for Submitted New Telemedicine Billing Codes:
Eligible payment programs to submit claims for K080A, K081A and K082A include Health Claims Payment program (HCP), Workplace Safety and Insurance Board (WCB)and Reciprocal Medical Billing (RMB) where the billing number is in the range of 010009 to 333798.
If a physician submits a claim with a billing number outside this range the claim will reject “V35-Invalid OOP/OOC Service”.
K080A-K083A require a diagnostic code to be submitted on the claim. If claim is submitted without a diagnostic code the claim will reject “V21-Diagnostic Code Required”. If a claim is submitted that exceeds the maximum number of services allowable for the temporary fee codes, the claim will reject “A3H-maximum number services FSM”.
If a claim is submitted under an Assessment Centre group number for these new K codes, the claim will reject “ESF-Not eligible to bill FSC”.
K080A-K082A will pay $0 with explanatory code “D7-Not allowed in addition to other procedure” when K083A has been previously paid or is on the same claim for same physician, patient and service date.
K083A can only be billed by specialists. If claim is submitted for K083A by physician with specialty code ‘00’ the claim will reject “A3F-No Fee for Service code”.
If a claim for K080A-K082A has already been paid or appears on the same claim for same physician, patient and service date and a claim is submitted for K083A, the claim will pay at $0 with explanatory code “D7-Not allowed in addition to other procedure”.
All new fee codes are excluded from telemedicine. If a claim is submitted with an SLI code ‘OTN’, the claim will reject “TM3-Service not payable under telemedicine”.
K083A-The fee will be set at $5.00 and the physician should submit the number of services necessary to make payment equivalent to a service provided, rounded to the nearest $5.00.
For Fee Schedule Codes using time units, calculate units by taking the normal fee and rounding it to the nearest $5, then divide that number by 5. For example, K197 (2 units or 46 minutes minimum) is $173.70 ($86.85 per unit). Now round that number to the nearest $5 ($175) and then divide by 5 = 35 units. Physicians should submit this number as the number of services on the claim and a fee billed of $175.For Fee Schedule Codes not based on time units round to the nearest $5 and divide by 5. For example, an A485 consultation is $170.10. This rounds to $170 or 34 units. This code would be billed at $170 with the number of services equal to 34.
K083A when billed by a Primary Care affiliated physician who has a non-‘00’ specialty and who bills with that specialty will pay FFS and the service will not accumulate to any caps or ceilings.