Ontario Health Insurance Plan

INFOBulletin

Increases to physician laboratory medicine fees-Kaplan Award

Laboratory Medicine Physician year 4 compensation increases to be made April 1, 2021


To: Laboratory Medicine Physicians working in Community Labs
Category: Physician Services
Written by: Claims Services Branch, Ontario Health Insurance Plan Division
Date issued: March 24, 2021
Bulletin Number: 210306


Background

The Ministry of Health (ministry) and the Ontario Medical Association (OMA) have been working together to implement compensation adjustments on eligible physician payments outlined in Section 21(a) of the Binding Arbitration Framework (BAF). This is in accordance with the Kaplan Board of Arbitration Award (Award) for year 4 (2019/2020).

The ministry and the OMA have come to an agreement that increases to physician compensation should be applied to some laboratory medicine fee schedule codes listed in the Schedule of Benefits for Physician Services (Schedule). These fee schedule codes are billed through community labs.

Retroactive Increases to Physician Laboratory Fees billed through Community Labs

Starting April 1, 2021, the list of fee codes below is being increased with an effective date of April 1, 2020. Due to the retroactive payment increase, a medical claims payment adjustment (MADJ) will be required. This is tentatively scheduled for the May 2021 Remittance Advice (RA).
The increase applies to the following fee schedule codes:

Fee Code

Previous value

New value

L800A

$21.70

$22.70

L805A

$81.20

$83.85

L806A

$35.80

$36.20

L810A

$23.40

$25.00

L820A

$7.00

$8.15

L826A

$13.35

$15.15

L829A

$13.70

$14.65

L834A

$13.35

$15.15

L835A

$13.35

$15.15

L841A

$13.35

$15.15

L843A

$21.50

$23.55

L844A

$13.60

$14.55

L846A

$12.20

$12.60

L849A

$13.90

$15.20

A585A

$68.60

$73.30

C585A

$64.70

$73.30

Medical Claims Payment Adjustment

All fee schedule codes in the table above submitted with service dates between April 1, 2020 and March 31, 2021 will be adjusted to pay at the new value. After the MADJ has been run, payment should occur on the May RA. Claims submitted after April 1, 2021 will pay at the new rate.

Claims that have been adjusted will show up on the RA with explanatory codes ’55-This deduction is an adjustment on an earlier account (system generated negate)’ and ’57-This payment is an adjustment on an earlier account’. The difference in payment will equal the difference between the old and new fee code amounts.

Keywords/Tags

Kaplan Award; arbitration; Year 4; community labs, MADJ; Laboratory Medicine;

Contact Information

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

For More Information

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TTY 1–800–387–5559.
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