Ontario Health Insurance Plan

INFOBulletin

Medical Claims Adjustment for E386A and E683A Fee Increases

Fee increases for fee schedule codes E386A and E683A which were effective April 1, 2020 are being processed for the November Remittance Advice (RA).


To: All Providers
Category: Physician Services
Written by: Claims Services Branch, Ontario Health Insurance Plan Division
Date issued: November 6, 2020
Bulletin Number: 201102


As awarded by the Kaplan Board of Arbitration, the Year 4 fee increases for the following Fee Schedule Codes (FSCs) were implemented on September 1, 2020 with an effective date of April 1, 2020:

  • E386A– Extradural decompression-spinal cord or cauda equina, tumour or infection

  • E683A– when performed thorascopically or by video-assisted thoracic surgery (VATS)

A Medical Claims Adjustment (MADJ) is being processed to adjust and pay the increase on claims submitted for E386A and E683A with service dates between April 1, 2020 and August 31, 2020. These adjustments will appear on the November 2020 Remittance Advice.

Medical Claims Adjustments (MADJ)

  • Please note that during the MADJ process, the claims processing system selects an entire claim for reprocessing.
  • A single claim can include multiple fee schedule codes and all codes will be reprocessed.
  • Claims that have been reprocessed will appear on the Remittance Advice (RA) with explanatory code ’55-This deduction is an adjustment on an earlier account’ and ’57-This payment is an adjustment on an earlier account’.

Keywords/Tags

E386; E683; Kaplan; Year 4

Contact Information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.

The latest version of the Schedule of Benefits for Physician Services is available on the Ministry of Health website. Hard copies of the Schedule of Benefits for Physician Services will not be distributed. If you would like to order a paper copy or compact disk (CD) of the Schedule for a fee, please visit Publications Ontario. Physicians without access to the Internet can contact ServiceOntario at 1-800-668-9938.

This bulletin is a general summary provided for information purposes only. Physicians are directed to review the Health Insurance Act, Regulation 552, and the schedules under that regulation, for the complete text of the provisions. You can access this information at ontario.ca/laws. In the event of a conflict or inconsistency between this bulletin and the applicable legislation and/or regulations, the legislation and/or regulations prevail.

Find INFOBulletins online on the Ministry of Health website.

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