Ontario Health Insurance Plan

INFOBulletin

Temporary Fees for Identified AGMPs in Community Settings

Physicians are now eligible to receive a temporary modifier OHIP payment for eligible AGMPs performed outside of hospitals.


To: Physicians
Category: Physician Services
Written by: Health Services Branch, Ontario Health Insurance Plan Divisio
Date issued: November 26, 2020
Bulletin Number: 201108


To further support the government’s efforts in responding to the COVID-19 outbreak in Ontario, the Ministry of Health (ministry) and the Ontario Medical Association (OMA) have reached an agreement to implement a temporary 30% modifier payment for eligible Aerosol-Generating Medical Procedures (AGMPs) performed outside of hospitals.


Temporary Modifier Payment for Community Based AGMPs

The new temporary modifier payment will be applicable to eligible AGMPs rendered in community settings on or between October 1, 2020 and March 31, 2021 and under the eligibility criteria noted below, unless the ministry and the OMA agree to further extensions.

The list of eligible AGMPs in community settings will mirror the list used for the equivalent modifier payment for AGMPs performed in hospitals, which was implemented as part of the larger COVID-19 temporary payments implemented for physician services in-hospital (please refer to INFOBulletin 4758 titled “Temporary Fees for Identified AGMP Procedures-COVID-19-Hospital Physician Compensation” for additional information). This list of eligible AGMPs is currently being expanded to include additional procedures.

All eligible AGMPs, including the current list of eligible AGMPs and additional procedures to be added by the ministry, are listed in Appendix A.

NOTE: The new temporary modifier for community-based AGMPs will only be eligible for payment on AGMPs when the AGMP:

  • Is rendered to patients who are COVID-19 positive, or at risk of being COVID-19 positive; and
  • Commences between the hours of 7 am and 5 pm on weekdays.

Patients defined as at risk of being COVID-19 positive in community settings include those who:

While payment for the provision of services associated with the new temporary modifier payment for community-based AGMPs is effective October 1, 2020, system changes are required in order to expand the list of eligible AGMPs and process payments for these services.

Physicians will need to wait to submit claims for these payments until further notification from the ministry, which will be communicated through a future INFOBulletin.

By claiming and accepting the temporary modifier payments, physicians will be deemed to agree to the following terms and conditions:

  • All payment requirements in the Schedule of Benefits for Physician Services that are applicable to the eligible AGMPs must also be met for these temporary modifier payments to be payable.
  • The same claims submission requirements for insured services in Regulation 552 under the Health Insurance Act must also be met when submitting claims for the temporary modifier payment described above.

Appendix A-Eligible AGMPs

Current List of Eligible AGMPs

Fee Schedule Code Descriptor April 2020 Price
Anaesthesia Anaesthesia unit fee $15.29
E600 Larynx-Endoscopy- Laryngoscopy- Using operating microscope-To charges for laryngoscopy add $33.60
G050 Trachea and Bronchi-Endoscopy-Bronchoscopy-Endobronchial ultrasound (EBUS), for guided biopsy of hilar and/or mediastinal lymph nodes

$203.05

G579 Echocardiography-Transoesophageal echocardiography-Saline study (including venipuncture, to G571, G574, G581 or G584 add $11.35
G580 Echocardiography-Transoesophageal echocardiography-Insertion of oesophageal transducer $45.00
G581 Echocardiography-Transoesophageal echocardiography-professional component (P1) $25.00
M012 Nose-Reconstruction-Septoplasty $293.95
M054 Accessory Nasal Sinuses-Endoscopic approach-Intranasal maxillary antrostomy -unilateral -by endoscopic or endonasal approach $123.70
M055 Accessory Nasal Sinuses-External or Endonasal Approach-Maxillary-Caldwell- Luc (includes intranasal antrostomy)-Unilateral $247.35
M056 Accessory Nasal Sinuses-Maxillectomy-Partial or complete $971.75
M061 Accessory Nasal Sinuses-External or Endonasal Approach-Sphenoid-Trans-Septal sphenoidectomy for tumour or radical exenteration of disease $355.65
M081 Larynx-Excision-Laryngectomy-Total $838.90
M083 Accessory Nasal Sinuses-Ethmoidectomy/antrostomy-Intranasal ethmoidectomy including maxillary antrostomy, with endoscope -unilateral (not eligible for payment with M061 or M054) $350.00
M084 Larynx-Excision-Laryngectomy-Segmental, including reconstruction $888.85
M086 Accessory Nasal Sinuses-Ethmoidectomy/antrostomy-Transnasal endoscopic repair of CSF rhinorrhea (includes harvesting of graft material) with or without 3D CT/MRI image guided system $822.45
M105 Chest Wall and Mediastinum-Excision-Chest wall tumour, resection of 2 or 3 ribs or cartilages $650.00
M135 Lungs and Pleura-Incision-Major decortication of lung for empyema or tumour $848.80
M137 Respiratory /Cardiovascular Surgical Procedures-Lungs and pleura-Incision-Multi-Thoracotomy with or without biopsy $390.65
M142 Lungs and Pleura-Excision-Pneumonectomy, may include radical mediastinal node dissection, sampling or pericardial resection requiring repair $1,485.40
M143 Lungs and Pleura-Excision-Lobectomy, may include radical mediastinal node dissection or sampling $1,402.60
M145 Lungs and Pleura-Excision-Wedge resection of lung $843.40
M149 Lungs and Pleura-Excision-Pleurectomy, and/or apical bullectomy for pneumothorax $525.00
M151 Lungs and Pleura-Excision-Bullectomy for major bullous disease $725.00
N111 Cranial-Skull Base Surgery-Resection of lesion(s)-Endonasal Approach-Pituitary lesion(s)-Transsphenoidal microscopic resection of lesion(s) originating in the sella turcica requiring simple closure, repair and/or reconstruction of surgical defect(s) $1,879.00
N112 Cranial-Brain-Skull Base Surgery -Surgical Access-Endonasal Approach-Surgeon not rendering resection of lesion(s)-Endonasal endoscopic or microscopic approach for surgical access to sella turcica-Includes when rendered middle turbinate reductions, maxillary antrostomies, ethmoidotomies, ethmoidectomies, sphenoidotomies, septotomy, septoplasty and septal mucosal flap(s) harvest associated with septotomy or sphenoidal mucosal flap(s) $1,360.00
N114 Cranial-Skull Base Surgery-Resection of lesion(s)-Endonasal Approach-Pituitary lesion(s)-Transsphenoidal endonasal endoscopic resection of lesion(s) originating in the sella turcica requiring simple closure, repair and/or reconstruction of surgical defect(s) $1,742.45
N116 Cranial-Skull Base Surgery-Resection of lesion(s)-Endonasal Approach-Non- Pituitary lesion(s)-Endonasal endoscopic resection of non- Pituitary lesion(s) not originating from pituitary tissue requiring simple closure, repair and/or reconstruction of surgical defect(s) $2,243.45
N150 Cranial-Cerebral Injury-C.S.F. leak-Intracranial repair (to include trans- Sphenoidal approach) $1,065.45
R181 Respiratory Surgical Procedures-Nose-Excision of nasopharyngeal or oropharyngeal lesion-With palatal split $508.20
S018 Oral Cavity and Pharynx-Excision-Glossectomy-Partial $197.45
S043 Salivary Glands and Ducts-Excision-Parotid gland-Total (with preservation of facial nerve) $885.75
S063 Oral Cavity and Pharynx-Excision-Branchial-Tonsillectomy and may include adenoidectomy $178.35
S065 Oral Cavity and Pharynx-Excision-Branchial-Adenoidectomy $101.25
S068 Oral Cavity and Pharynx-Excision-Closure of fistula-Pharyngo- Laryngectomy $1,155.45
S236 Endoscopic Ultrasound-Linear or radial echo- Endoscope-Excluding biliary or pancreatic examination (scope also used for therapeutic procedures) $203.05
S237 Endoscopic Ultrasound-Linear or radial echo- Endoscope-Including biliary and/or pancreatic examination (scope also used for therapeutic procedures) $253.80
Z292 Laryngoscopy Direct without biopsy $61.30
Z293 Laryngoscopy Direct with biopsy $61.30
Z296 Nose-Endoscopy-Fiberoptic endoscopy of upper airway (nose, hypopharynx or larynx) (IOP)-With flexible endoscope-If only operative procedure performed $20.10
Z299 Nose-Endoscopy-Fiberoptic endoscopy of upper airway (nose, hypopharynx or larynx) (IOP)-With rigid endoscope, for Diagnostic evaluation, or to facilitate biopsy or surgical treatment of pathology in the posterior nasal cavity, hypopharynx or larynx $8.55
Z301 Nose-Incision-Drainage of abscess or haematoma $55.60
Z302 Nose-Incision-Turbinate reduction-Unilateral or bilateral (by any method) $55.60
Z305 Nose-Excision-Nasal polyp-Multiple or involving general anaesthetic-Unilateral $55.60
Z311 Nose-Excision-Removal of foreign body-Local anaesthetic $10.55
Z312 Nose-Excision-Removal of foreign body-General anaesthetic $50.90
Z314 Nose-Treatment of epistaxis (nasal Haemorrhage)-Cauterization-Unilateral $11.50
Z315 Nose-Treatment of epistaxis (nasal Haemorrhage)-Anterior packing-Unilateral $15.35
Z316 Nose-Treatment of epistaxis (nasal Haemorrhage)-Posterior packing-Unilateral or bilateral $35.50
Z317 Nose-Endoscopy-Fiberoptic endoscopy of upper airway (nose, hypopharynx or larynx) (IOP)-Examination under anaesthesia (EUA) of nose including suction cautery for posterior epistaxis-Unilateral or bilateral $112.05
Z318 Accessory Nasal Sinuses-Endoscopic approach-Trephine or endoscopic frontal sinusotomy $133.30
Z322 Larynx-Endoscopy-Direct-With removal of foreign body $106.45
Z323 Larynx-Endoscopy-Direct-With removal of lesion(s) $226.35
Z324 Larynx-Endoscopy-Indirect-With biopsy or removal of foreign body $44.70
Z325 Trachea and Bronchi-Incision-Emergency tracheotomy $474.65
Z326 Trachea and Bronchi-Tracheo-Bronchial aspiration-Change of tracheostomy tube $12.50
Z327 Trachea and Bronchi-Endoscopy-Bronchoscopy-Flexible or rigid, with or without bronchial biopsy, suction or injection of contrast material $124.90
Z329 Chest Wall and Mediastinum-Endoscopy-Mediastinoscopy $380.00
Z331 Lungs and Pleura-Introduction-Thoracentesis-Aspiration for Diagnostic sample $32.45
Z332 Lungs and Pleura-Introduction-Thoracentesis-Aspiration with therapeutic drainage with or without Diagnostic sample $59.15
Z334 Lungs and Pleura-Introduction-Thoracentesis-Total unilateral lung lavage with or without bronchoscopy using Double Lumen Tube and single lung anaesthesia $304.60
Z335 Thoracoscopy (pleuroscopy) with or without pleural biopsy, suction, etc. $242.35
Z336 Lungs and Pleura-Incision-Biopsy of pleura, needle-Including Diagnostic aspiration $59.15
Z338 Lungs and Pleura-Excision-Biopsy of pleura or lung-With limited thoracotomy $202.80
Z340 Lungs and Pleura-Incision-biopsy of lung, needle $137.85
Z341 Lungs and Pleura-Incision-Closed drainage effusion or pneumothorax $76.80
Z342 Trachea and Bronchi-Limited bronchoscopy with placement of endobronchial blocker and/or double lumen tube $112.55
Z343 Larynx-Endoscopy-Direct-With dilatation of larynx, to include bronchoscopy if necessary $202.35
Z344 Trachea and Bronchi-Tracheo-Bronchial aspiration-First procedure $45.95
Z345 Trachea and Bronchi-Tracheo-Bronchial aspiration-Subsequent procedures performed by same physician $18.60
Z346 Trachea and Bronchi-Tracheo-Bronchial aspiration-Transtracheal aspiration $22.35
Z350 Accessory Nasal Sinuses-Endoscopic approach-Ethmoidectomy/antrostomy-Endoscopic sphenoidotomy-Unilateral $123.70
Z355 Trachea and Bronchi-Quadroscopy or panendoscopy-With or without biopsy (nasopharyngoscopy, laryngoscopy, bronchoscopy, oesophagoscopy with or without gastro-duodenoscopy) using separate instruments in search of malignant disease $321.45
Z356 Trachea and Bronchi-Tracheo-Bronchial aspiration-Closure of persistent tracheostoma $133.95
Z359 Trachea and Bronchi-Repeat bronchoscopy for tracheobronchial toilet when performed within one week of another bronchoscopic procedure $56.65
Z360 Trachea and Bronchi-Endoscopy-Bronchoscopy-Emergency rigid bronchoscopy for obstructed airway $474.65
Z361 Lungs and Pleura-Incision-Chronic indwelling pleural catheter for palliative management of malignant pleural effusion-Insertion of indwelling catheter $200.00
Z399 Oesophagus-Endoscopy-Oesophagoscopy- Gastroscopy, with or without duodenoscopy-Elective $92.50
Z400 Oesophagus-Endoscopy-Oesophagoscopy- Gastroscopy, with or without duodenoscopy-for active bleeding $125.10
Z515 Oesophagus-Endoscopy-Oesophagoscopy, with or without biopsy(ies) $68.25
Z524 Oral Cavity and Pharynx-Incision-Drainage of haematoma or deep neck abscess (external approach) $271.05
Z527 Stomach-Endoscopy-Gastroscopy-May include biopsies, photography and removal of polyps less than or equal to 1 cm $82.90
Z528 Gastroscopy-subsequent (within three months following previous gastroscopy) $67.85
Z547 Stomach-Endoscopy-Gastroscopy-With removal of foreign body $99.75
Z558 Biliary Tract-Endoscopy-Endoscopic retrograde cholangiopancreatography (ERCP)-Including sphincterotomy and may include removal of one or more bile duct stones $300.25
Z561 Biliary Tract-Endoscopy-Endoscopic retrograde cholangiopancreatography (ERCP)-With cannulation of common bile duct and/or pancreatic duct $213.15
Z584 Intestines (except rectum)-Endoscopy-Small bowel push enteroscopy $185.15
Z738 Trachea and Bronchi-Incision-Insertion of Montgomery “T” Tube or similar laryngeal or tracheal stent $216.10
Z741 Trachea and Bronchi-Incision-Tracheotomy $273.15
Z760 Biliary Tract-Endoscopy-Endoscopic retrograde cholangiopancreatography (ERCP)-Through gastrojejunostomy following previous Billroth II $251.85

AGMPs to be Added to the Eligible List

The following procedures, when requiring the use of a high-speed device in the respiratory tract, are eligible for the AGMP premium when performed on patients who are COVID-19 positive or who are treated as at risk of COVID-19 positive:

Fee Schedule Code Descriptor April 2020 Price
F138 Mandible-Closed reduction, includes maxillary-mandibular fixation $350.00
F139 Mandible-Open reduction, per fracture, to include intermaxillary fixation $575.00
F140 Mandible-Removal of intermaxillary fixation device(s) $100.00
E173 Orbit-Open reduction rim/wall fracture-Zygomatic fracture dislocation $594.70
E174 Orbit-Blowout fracture of floor $667.00
F143 Midface fractures-Application of craniofacial suspension wires and external fixation devices (not to be billed in addition to maxillary repair)-Middle ¼ facial $577.65
F144 Midface fractures-Application of craniofacial suspension wires and external fixation devices (not to be billed in addition to maxillary repair)-Cranial-facial separation $1,594.90
F142 Orbit with maxilla-With wiring and local fixation $685.20
M063 Maxillectomy-Coronal and/or osteoplastic procedure for frontal sinusectomy, reconstruction or obliteration-Unilateral or bilateral $716.25

Additional eligible procedures when requiring open suctioning of the airway:

Fee Schedule Code

Descriptor

April 2020 Price

Z317

Endoscopy-Examination under anaesthesia (EUA) of nose including suction cautery for posterior epistaxis-Unilateral or bilateral $112.05

Z314

Treatment of epistaxis (nasal haemorrhage)-Cauterization-Unilateral $11.50

E839

Excision-Nasal polyp-With flexible endoscope, to Z304 $19.20

M027

Treatment of epistaxis (nasal haemorrhage)-Ligation of external carotid artery-Unilateral $297.25

R788

Treatment of epistaxis (nasal haemorrhage)-Ligation of internal maxillary artery-Unilateral $408.10

R789

Treatment of epistaxis (nasal haemorrhage)-Ligation of anterior ethmoidal artery-Unilateral $299.85

Z313

Treatment of epistaxis (nasal haemorrhage)-Endoscopic transnasal ligation of the sphenopalatine artery for posterior epistaxis-Unilateral $123.70

M144

Segmental resection, including segmental bronchus and artery $1,441.75

Keywords/Tags

COVID-19; Aerosol-Generating Medical Procedures; AGMP; modifier payment.

For more information

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

Find INFOBulletins online on the Ministry of Health website.

Schedule of Benefits for Physician Services

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.

Please review the Health Insurance Act

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.

For More Information

Call ServiceOntario, Infoline at:
1–866–532–3161 (Toll–free)
In Toronto, (416) 314–5518
TTY 1–800–387–5559.
In Toronto, TTY (416)327–4282
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