Ontario Health Insurance Plan

INFOBulletin

Point of Care Drug Testing

Four point of care drug testing services eligible for payment with virtual care K-codes


To: All Physicians
Category: Physician Services
Written by: Claims Services Branch, Ontario Health Insurance Plan Division
Date issued: April 9, 2021
Bulletin Number: 210404


Background

Further to INFOBulletin 210402, the change to include four point of care drug testing services to be billed with virtual care K-code services (K080, K081, K082 and K083) has been implemented April 1, 2021.

The effective date for this change is retroactive to March 14, 2020.

Claims Processing

This means that virtual care K-codes that have been submitted will now be counted towards the minimum consult and visit requirements for the following four point of care drug testing services: G040, G041, G042 and G043. These codes will no longer be rejected with error code ‘AMR-Min SRV Reqmnts not met’ when one of the virtual care K-codes is paid on history or on the same claim to the same physician for the same patient within the same month, and all other requirements have been met. Eligible claims that previously rejected with error code AMR can now be resubmitted. Stale date exemption will be applied to these claims until June 30, 2021.

Effective March 14, 2021, the Schedule of Benefits for Physician Services (Schedule) has been amended to temporarily permit K080, K081, K082 and K083 to be included as a consultation or assessment for the purposes of meeting the requirements for payment of G040, G041, G042 and G043, despite any requirement in the Schedule for a direct physical encounter with the patient.

Keywords/Tags

G040; G041; G042; G043; K080; K081; K082; K083; point of care

For more information

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

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.

This bulletin is a general summary

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
Hours of operation: Monday to Friday, 8:30am – 5:00pm

 
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