Virtual care K-Codes K080A, K081A and K082A are eligible for the Family Health Group (FHG) 10% comprehensive care premium effective March 14, 2020

To: Family Health Group Providers
Category: Primary Health Care Services
Written by: Negotiations Branch, Ontario Health Insurance Plan Division
Date Issued: October 9, 2020

To continue supporting the government’s efforts in response to the COVID-19 outbreak in Ontario, the Ministry of Health (ministry), working with the Ontario Medical Association (OMA), has reached an agreement to temporarily fund the Family Health Group (FHG) 10% comprehensive care premium for eligible virtual care K-codes effective March 14, 2020.

The virtual care K-codes, K080A, K081A and K082A, are eligible for the 10% comprehensive care premium when claimed by a FHG signatory or locum provider, for an enrolled or assigned patient of a physician in the FHG on the telemedicine service date.

This system change will be implemented October 1, 2020 with payments appearing on the November 2020 Remittance Advice (RA). A Medical Claims Adjustment (MADJ) will be performed on all eligible virtual care K-code claims previously submitted for service dates on or after March 14, 2020 and prior to the date of implementation.

Please note during the MADJ process, the claims processing system selects an entire claim and reprocesses it.

A single claim can include multiple codes and all codes will be reprocessed. Claims that were reprocessed with no change in payment will appear on the RA with explanatory code ‘55-This deduction is an adjustment on an earlier account’ and ‘57-This payment is an adjustment on an earlier account’. These two transactions will net out to zero with no payment impact but will report on the RA for reconciliation purposes.

Payment of the FHG 10% comprehensive care premium for the virtual care K-codes will end when the Ministerial Order that established the temporary virtual care K-codes is no longer in force.

Keywords/tags

COVID-19; Family Health Group; FHG; Comprehensive Care Premium; Virtual Care; K080; K081; K082

For more information

For any further inquiries, please contact the Service Support Contact Centre via email or by phone at 1-800-262-6524.