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Ministry Status: Routine Monitoring and Engagement

Ontario Health Insurance Plan

OHIP Bulletins


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

Interprovincial Health Care InfoBulletins

To:  All Health Care Providers

Published by:  Claims Services Branch

Date Issued:  August 1, 2017

Bulletin Number:  NA82

Re:  Interprovincial Out-patient Chemotherapy Billing Rates Effective September 1, 2017

Posted Electronically Only

PDF Version Portable Document Format | 134 Kb | 
See also:
Interprovincial Billing Out-Patient Rates Effective for Visits on or after September 1, 2017 [PDF]

The purpose of this INFOBulletin is to inform Ontario hospitals of changes to the interprovincial out-patient chemotherapy billing rates effective for visits occurring on or after September 1, 2017.

The Interprovincial Health Insurance Agreements Coordinating Committee (IHIACC) is reviewing and updating the interprovincial hospital billing rates, beginning with out-patient chemotherapy.  Additional rates and rules of application will be updated as IHIACC continues its review.

The previous billing rate of $1,460 for out-patient chemotherapy (code 06) will be replaced with the following billing codes/rules to allow hospitals to recover full drug costs for out-of-province patients:

Code 06: Low Cost Chemotherapy Drugs totaling less than $1,000 per visit: Bill a visit fee of $346 PLUS the actual acquisition cost of the drugs.  No invoice is required.

New Code 16: High Cost Chemotherapy Drugs totaling $1,000 or greater per visit: Bill a visit fee of $346 PLUS the actual acquisition cost of the drugs.  Invoice is required.  Prior approval from the home jurisdiction must be obtained for drugs over $3,000.

Claims submitted under Code 16 must be accompanied by a hospital invoice that indicates the patient’s name, health number, date of administration and the cost of the drugs used in the visit.

Prior approval must be obtained for drugs when the total cost of drugs provided during a visit is $3,000 or greater.  Treatment should not take place until prior approval has been obtained.

See attachment titled:

NA82 – Attachment - Interprovincial Out-Patient Rates Effective September 1, 2017

Please share a copy of this INFOBulletin with your hospital’s billing department.

Please direct any questions regarding the new chemotherapy rates to the ministry by emailing mailto:InterprovinceBilling.moh@ontario.ca.

Thank you for your cooperation.

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