New payment rules are being applied to fee schedule codes: A210 and C210

To: All Physicians
Category: Physician Services
Written by: Claims Services Branch, Health Programs and Delivery Division
Date issued: July 12, 2024
Bulletin Number: 240701

Background

The Ministry of Health and the Ontario Medical Association have been working together to implement the 2021 Physician Services Agreement.

As described in INFOBulletin 230310, permanent adjustments to fee schedule codes within the Schedule of Benefits for Physician Services (the schedule) have been made effective April 1, 2023. Adjustments to the claims payment system related to these schedule changes are being introduced through staged implementations to ensure correct payment of claims in accordance with the schedule.

The following Release 13 changes are being implemented July 1, 2024, with an effective date of April 1, 2023.

The following fee schedule codes (FSCs) were affected by the change:

  • A210 - Special Anaesthetic Consultation – Office
  • C210 - Special Anaesthetic Consultation – Hospital

Claims submission

A210A and C210A are eligible for payment within the same 12/24-month limits as other consultation codes. (Please refer to the relevant payment rules on page GP17 of the schedule). Services exceeding the limit will reject with error code ‘AC1 - Maximum reached-resubmit alternate FSC’. A210A and C210A will not be converted to a lesser paying code.

Please note: Consultations receiving an AC1 error may be submitted using the appropriate assessment code listed in the schedule.

A210A and C210A are eligible for payment virtually when provided by video, with the K300A modality.

A210A and C210A will be approved at zero dollars when billed with telephone modality code K301A with explanatory code ‘B1 - Service Not Eligible for Payment when Delivered by Telephone.’

A210A and C210A provided by video will establish the patient/physician relationship for comprehensive virtual care.

Medical Claims Adjustments (MADJ)

Due to staged implementations, Medical Claims Adjustments may be required. Further information will be provided in advance of a Medical Claims Adjustment.

Keywords/Tags

A210A; C210A; K301A; Special Anaesthetic Consultation; Physician Services Agreement; PSA; Physician Payment Committee; PPC

Contact information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524. Hours of operation: 8:00 a.m. to 5:00 p.m. Eastern Monday to Friday, except holidays.