Bulletin 241001 — New Specialty in Palliative Medicine

To: Physicians
Category: Physician Services
Written by: Provider Services Branch, Physician and Provider Services Division
Date issued: October 1, 2024
Bulletin Number: 241001

Overview

Following consultation with the Ontario Medical Association (OMA), the Ministry of Health (ministry) has created a new billing specialty designation under the Ontario Health Insurance Plan (OHIP) for Palliative Medicine, effective October 1, 2024.

Billing specialties are assigned by the ministry when physicians register for a billing number and must be used when submitting claims. In order to be assigned a billing specialty, the physician must have the appropriate specialty or subspecialty, as recognized by the College of Physicians and Surgeons of Ontario (CPSO).

The new OHIP billing specialty designation for Palliative Medicine has been assigned number “45” in the OHIP claims system.

Eligibility

In order to obtain the Palliative Medicine billing specialty, the physician must have a subspecialty in Palliative Medicine as recognized by the CPSO.

In order to obtain the CPSO subspecialty, a physician must hold a Palliative Medicine subspecialty certification from the Royal College of Physicians and Surgeons of Canada (RCPSC).

If a physician does not hold the RCPSC subspecialty certification but believes they are eligible, they should contact the CPSO directly in order to assess their eligibility.

Registration process

Register for the new OHIP billing specialty designation by emailing Provider Registration Services Unit at ProviderRegistration.MOH@ontario.ca. Include in the email:

• A statement the “Palliative Medicine” billing specialty designation is being requested;
• The specified date of the designation on or after October 1, 2024;
• Physician’s current OHIP billing number; and
• Physician’s CPSO number.

The Palliative Medicine billing specialty is effective as of October 1, 2024, and registrations can be backdated to October 1, 2024, or the effective date of the physician’s CPSO subspecialty in Palliative Medicine, whichever is later.

The ministry will verify the physician’s registration with the CPSO and verify that the physician has a subspecialty in Palliative Medicine as recognized by the CPSO. Following completion of this verification process, the ministry will notify the physician by email that the registration is complete, and the Palliative Medicine billing specialty (45) has been assigned. The registration date will also be noted in the ministry’s email sent back to the physician.

The new billing specialty can also be requested by calling the ministry’s Service Support Contact Centre (SSCC) at 1-800-262-6524.

Submitting claims

Once the registration process is complete and a physician has been assigned the Palliative Medicine billing specialty designation in the OHIP claims system, the physician can begin submitting claims using their new designation. Please note that even with backdating registration, the ministry’s existing stale-date policy still applies. Physicians have 3 months from the service date to submit claims.

A physician can hold more than one billing specialty, but each claim can only be submitted with one billing specialty. When submitting claims, the physician must indicate on each claim which eligible billing specialty designation applies, as appropriate based on the applicable insured service(s) on the claim(s).

Currently in the Schedule of Benefits for Physician Services there is no ‘Consultation and Visits’ general listings for Palliative Medicine and the new “45” billing specialty can only be used to submit claims for fee codes that are not restricted to other billing specialties (example: the “45” palliative medicine billing specialty cannot be used to submit claims for fee codes restricted to the “13” billing specialty for internal medicine, claims submitted with the new “45” billing specialty designation which are restricted to a different billing specialty, such as the “13” billing specialty for internal medicine, will reject with the error code ‘A4D - Ineligible Specialty’).

For any fee codes that are otherwise unrestricted, including special palliative care consultation, palliative care support, palliative care subsequent visits and palliative care case management fee codes listed either in the Family Practice & Practice in General or the Diagnostic and Therapeutic Procedures section of the Schedule of Benefits for Physician Services, these could be claimed using the “45” billing specialty code.

Any claim submitted with the new “45” billing specialty designation must have a service date after the registration date noted in the email to the physician from the ministry. Claims submitted with billing specialty “45” prior to the physician being assigned the billing specialty by the ministry will reject with error code ‘EQ2 - Specialty Mismatch’. Claims submitted with billing specialty “45” and a service date prior to October 1, 2024 will reject with the error code ‘EQ2 - Specialty Mismatch’.

Keywords/Tags

OHIP; Billing Specialty; Palliative Medicine; Specialty Code

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.