The Ministry of Health (ministry) and the Ontario Medical Association (OMA) have been working together to implement the 2021 Physician Services Agreement (PSA).
Effective December 1, 2022, the Schedule of Benefits (the Schedule) has been amended to reflect the new virtual care funding framework, as set out in the PSA and communicated in INFOBulletin 221002.
The new virtual care model is only applicable to service dates on or after December 1, 2022. For virtual services rendered prior to December 1, 2022, providers may continue to bill using the temporary COVID-19 K-codes and/or through the Ontario Virtual Care Program.
COVID-19 Virtual Care K-Codes
The existing K080A-K083A and K092A-K095A virtual care K-codes will be ended on November 30, 2022. Claims submitted with a service date of December 1, 2022, or later will reject to the provider’s error report with error code ‘A3E – No Such F.S Code’.
Modality Indicators
Effective December 1, 2022, physicians will continue to use the K300A (Video) or K301A (Telephone) modality indicators to identify the technology used to deliver the service when claiming comprehensive virtual care services. These fee codes must be submitted on the same claim using the same service date as the eligible insured virtual service.
If a claim has both a Video and Telephone modality on a matching service date, the claim will reject to the provider’s error report with new error code ‘AT1 – Only One Modality Allowed’.
The modality indicators cannot be claimed alone. If a K300A or K301A is submitted as the sole code on a service date, it will reject to the provider’s error report with error code ‘AD8 – Not Allowed Alone’.
For new virtual care claims with service dates on or after December 1, 2022, the tracking codes K300A and K301A will pay at $0.00 and now be processed with an explanatory code of ‘30’.
Claims submitted for the temporary COVID-19 virtual K-codes with service dates prior to December 1, 2022, will continue to have the K300A and K301A processed with an explanatory code of ‘33’.
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