Release 10 changes
The following Release 10 changes were implemented on April 1, 2024 with an effective date of April 1, 2023: E098A – Gastroenterology Chronic Disease Assessment Premium
E098A is only payable to physicians with an OHIP specialty of 41 (Gastroenterology).
Claims processing
E098A will pay a 28% premium on the fee approved value of FSCs A411A, A413A, A414A, and A418A (relevant codes) with the following diagnostic codes only:
- 555 – Other Diseases of Intestine and Peritoneum: Regional enteritis, Crohn’s disease
- 556 – Other Diseases of Intestine and Peritoneum: Ulcerative colitis
- 571 – Other Diseases of Digestive System: Cirrhosis of the liver (alcoholic cirrhosis, biliary cirrhosis)
If E098A is submitted with a diagnostic code other than 555, 556, or 571, the claim will reject to the physician’s error report with error code V30 – FSC/DX Code Combination not a benefit.
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