Bulletin 230331 — Year 3 Increase: St. Joseph’s Health Centre
Permanent adjustments of the Year 1 and Year 2 increases will be effective April 1, 2023.
To: St. Joseph’s Health Centre (SJHC) Physicians
Category: Primary Health Care Services, Physician Services
Written by: Negotiations Branch, Physician and Provider Services Division
Date issued: April 1, 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 10% to 15% of the approved amount on all shadow-billed claims.
Base payment increase
Effective April 1, 2023, the following payment elements under your funding agreement will be increased by 31% and will be reflected on your May 2023 Remittance Advice (RA):
- Base Payment
Fee-For-Service Threshold increase
Effective April 1, 2023, the Fee-For-Service billing limits for core services provided to non-enrolled patients will be increased by 2.6186%.
New Fee Schedule Codes effective April 1, 2023
Effective April 1, 2023, the following new services have been introduced. The services when billed with a ‘B-Suffix’ or ‘C-Suffix’, as indicated, have been added to the basket of ‘Excluded Codes’ for the St. Joseph’s Health Centre patient enrolment model.
| Fee Code | Description |
|---|---|
| R102B R102C |
Level 1 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancy |
| R158B R158C |
Level 2 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancy |
| R159B R159C |
Level 3 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancy |
| R740B R740C |
Left atrial appendage occlusion/excision by suture or device, Sole procedure |
| Z516C | Excision of first polyp (20 mm to 29 mm) |
| Z517C | Excision of first polyp (10 mm to 19 mm) |
| Z518C | Excision of first polyp (6 mm to 9 mm) |
| Z844C | Diagnostic Paracentesis for: 1) suspected intraocular infection; 2) intraocular inflammation / uveitis; or 3) suspected cancer involving the intraocular structures or fluids |
Deleted Fee Schedule Codes effective April 1, 2023
Effective April 1, 2023, the following services have been delisted and removed from the basket of ‘Excluded Codes’ for the St. Joseph’s Health Centre patient enrolment model.
| Fee Code | Description |
|---|---|
| H400 | Emergency Department Sessional Fees-Sessions-Monday-Friday (other than holidays)-2000h-2400h |
| H401 | Emergency Department Sessional Fees-Sessions-Monday-Friday (other than holidays)-0000h-0400h |
| H402 | Emergency Department Sessional Fees-Sessions-Monday-Friday (other than holidays)-0400h-0800h |
| H403 | Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-0000h-0400h |
| H404 | Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-0400h-0800h |
| H405 | Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-0800h-1200h |
| H406 | Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-1200h-1600h |
| H407 | Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-1600h-2000h |
| H408 | Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-2000h-2400h |
New service 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.
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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