Ontario Health Insurance Plan

INFOBulletin

Increases to physician laboratory medicine fees-Kaplan award

Year 4 compensation increases for laboratory medicine fee codes to be paid on May 2021 Remittance Advice (RA)


To: Laboratory Medicine Physicians
Category: Physician Services
Written by: Claims Services Branch, Ontario Health Insurance Plan Division
Date issued: April 23, 2021
Bulletin Number: 210405


Background

Further to INFOBulletin #210306, the Medical Claims Adjustment (MADJ) for the retroactive increases to Physician Laboratory Fees is being processed. This will be completed in April for payment on the May 2021 Remittance Advice (RA).

Retroactive Increases to Physician Laboratory Fees

The fee codes below were retroactively increased effective April 1, 2020. Adjustments to these codes will be reported on the May 2021 RA.

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.

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; MADJ; Laboratory Medicine

Contact 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.

For More Information

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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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