Keeping Health Care Providers informed of payment, policy or program changes

To: All providers
Published by: Claims Services Branch, Ministry of Health
Date Issued: February 28, 2020

Kaplan Board of Arbitration Award – Appropriateness Working Group (AWG)

As directed by the February 2019 Kaplan Board of Arbitration Award, the Ministry of Health and the Ontario Medical Association (OMA) formed the Appropriateness Working Group (AWG) with a mandate to use evidence, best practices and expert opinion to decrease the provision of medically unnecessary or inappropriate services without decreasing access to medically necessary services.

A. New fee codes – Level 2 holter monitors: 14 or more days of recording

Effective for service dates on or after October 1, 2019, three new fee schedule codes (FSC) have been created for Level 2 Holter Monitors 14 or more days. The three new codes are:

  • G694A – Technical component – 14 or more days of recording
  • G695A – Technical component – 14 or more days scanning
  • G696A – Professional component – 14 or more days recording

Note: as stated on page J14 of the Schedule, under payment note 3:G647, G648, G649, G694, G695 and G696 are only eligible for payment once per 30 day period per patient.

B. Reminder – Appropriate billing of holter monitor codes

Below is a listing of all Level 1 and Level 2 Continuous ECG Monitoring codes, including the three new Level 2 codes for Holter Monitors 14 or more days.

Note:  As stated on page J14 of the Schedule, under payment note 2:

  • Where the duration of the service is more than 36 hours, claims for such services must be submitted using the appropriate listed code for that time duration and cannot be submitted using multiples of lesser time duration codes.

Continuous ECG monitoring (E.G. HOLTER)

Level 1
Requires a device capable of recording three or more simultaneous channels and the acquisition of a continuous ambulatory electrocardiographic recording of all beats, using three or more skin electrodes. The device must also have the ability to analyze and manually review all parts of the recording, and to produce graphical and quantitative reports of relevant parameters and diagnostic quality tracings for visual review, including post–hoc review of any portion of the recording to enable diagnostic rhythm analysis. Must include a patient diary and event marker capability to enable symptom–rhythm correlation.

Minimum 12 hours of monitoring.

  • G651 technical component – 12 to 35 hours recording – 23.90
  • G652 technical component – 12 to 35 hours scanning – 32.70
  • G650 professional component – 12 to 35 hours recording – 47.90
  • G682 technical component – 36 to 59 hours recording – 47.80
  • G683 technical component – 36 to 59 hours scanning – 65.40
  • G658 professional component – 36 to 59 hours recording – 75.45
  • G684 technical component – 60 hours to 13 days recording – 71.65
  • G685 technical component – 60 hours to 13 days scanning – 98.10
  • G659 professional component – 60 hours to 13 days recording – 95.85
  • G647 technical component – 14 or more days recording – 112.65
  • G648 technical component – 14 or more days scanning – 164.00
  • G649 professional component – 14 or more days recording – 122.25

Level 2
All other monitoring devices with fewer than three skin electrodes, or that record only portions of the monitoring period or do not provide trend analysis. Minimum 12 hours monitoring.

  • G654 technical component – 12 to 35 hours recording – 22.80
  • G655 technical component – 12 to 35 hours scanning – 15.60
  • G653 professional component – 12 to 35 hours recording – 34.10
  • G686 technical component – 36 to 59 hours recording – 45.60
  • G687 technical component – 36 to 59 hours scanning – 31.20
  • G656 professional component – 36 to 59 hours recording – 51.15
  • G688 technical component – 60 hours to 13 days recording – 68.40
  • G689 technical component – 60 hours to 13 days scanning – 46.85
  • G657 professional component – 60 hours to 13 days recording – 68.20
  • G694 technical component – 14 or more days recording – 107.02
  • G695 technical component – 14 or more days scanning – 78.72
  • G696 professional component – 14 or more days recording – 86.80

Services related to external cardiac loop recording devices that rely solely on patient activation to record electrocardiographic data and do not have the capability of real–time rhythm analysis are not insured.

For details related to the AWG changes to the Schedule effective October 1, 2019, please refer to INFOBulletin # 4726 Kaplan Board of Arbitration Award – Appropriateness Working Group (AWG): Changes to the Schedule are effective October 1, 2019.

For any further inquiries, please contact the Ministry of Health Service Support Contact Centre at 1-800-262-6524.