Permanent adjustments of the Year 1 and Year 2 increases will be effective April 1, 2023.

To: Rural and Northern Physician Group Agreement (RNPGA) Physicians-Groups 1 & 2
Category: Primary Health Care Services, Physician Services
Written by: Negotiations Branch, Physician and Provider Services Division
Date issued: March 31, 2023

The Ministry of Health and the Ontario Medical Association have been working together to implement physician compensation increases in accordance with the 2021 Physician Services Agreement (PSA).

The PSA provides for Year 1 and Year 2 compensation increases to be implemented as permanent adjustments to physician payments effective April 1, 2023. The permanent increase amounts vary according to relativity as outlined in the PSA. They are allocated to each section or physician grouping, as per page 6 of the Financial Agreement of the PSA.

Blended Fee-For-Service (BFFS) premium increase

Effective April 1, 2023, BFFS premium payments will increase from 5% to 9.65% of the approved amount on all shadow-billed claims.

New services eligible for after-hours

Effective April 1, 2023, the new service ‘K133A-Periodic Health Visit for Adults with Intellectual and Developmental Disabilities’ is eligible for the after-hours premium when billed with a Q012A for enrolled patients.

Effective April 1, 2023, the new service ‘G552-Removal of intrauterine contraceptive device (IUD)’ will pay Fee-For-Service (FFS) when billed with a Q022A where eligible.

Effective April 1, 2023, the following new services when billed with a ‘B-Suffix’ or ‘C-Suffix’ will pay FFS when billed with the Q022A where eligible:

Fee Code Description
Z844 Diagnostic Paracentesis for: 1) suspected intraocular infection; 2) intraocular inflammation / uveitis; or 3) suspected cancer involving the intraocular structures or fluids
Z518 Excision of first polyp (6 mm to 9 mm)
E520 Excision of each additional polyp (6 mm to 9 mm)
Z517 Excision of first polyp (10 mm to 19 mm)
E519 Excision of each additional polyp (10 mm to 19 mm)
Z516 Excision of first polyp (20 mm to 29 mm)
E518 Excision of each additional polyp (20 mm to 29 mm)
R102 Level 1 oncoplastic breast conserving lumpectomy or

 

partial mastectomy for malignancy

R158 Level 2 oncoplastic breast conserving lumpectomy or

 

partial mastectomy for malignancy

R159 Level 3 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancy
R740 Left atrial appendage occlusion/excision by suture or device, Sole procedure
Z352 Intrapleural administration of thrombolytic or fibrinolytic agent via thoracostomy tube (chest tube)
Z363 Removal of thoracostomy tube (chest tube)

Fee Schedule code increases effective April 1, 2023

Effective April 1, 2023, the Fee Schedule Master (FSM) will be updated to reflect new values for fee-for-service (FFS) codes as agreed to between the ministry and the OMA at the Physician Payment Committee (PPC). For more information, please see INFOBulletin 230310.

Keywords/Tags

Physician Services Agreement; PSA; physicians; payments

Contact information

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