A957

PDF page 78 / GP64

2. Despite any other provision in this Schedule, the amount payable for the following services to
     an insured person who is at least 65 years of age, as those services are defined in this
     Schedule, is increased by 15 per cent:
     a. A general assessment (A003, C003, W102, or W109);
     b. A general re-assessment (A004, C004, W004);
     c. An intermediate assessment (A007);
     d. A focused practice assessment (A917, A927, A937, A947, A957 or A967);
     e. A periodic health visit (K132).
     f. Comprehensive assessment and care (H102, H122, H132, H152)
     g. A multiple systems assessment (H103, H123, H133, H153)

PDF page 137 / A9

CONSULTATIONS AND VISITS
      FAMILY PRACTICE & PRACTICE IN GENERAL (00)
                                          Payment rules:
                                          1.K133 is limited to one per patient per 12 month period.
                                          2.Only one of K133, K131, or K132 is eligible for payment per patient per physician per 12
                                            month period.
                                          3.This service can be provided over multiple distinct time periods, however, a minimum of 50
                                            minutes total time spent in direct contact with the patient is required, exclusive of time spent
                                            rendering any other separately billable intervention to the patient. Start and stop times must
                                            be recorded for each time period related to the service. For payment purposes, the service
                                            date on the claim must be the date on which all requirements for the service have been
                                            completed. No other services are eligible for payment for time periods used to meet the time
                                            requirements of this service.
                                          4.While some aspects of K133 may be provided virtually, a minimum of 26 minutes must be
                                            provided through direct physical encounter(s).
                                          5.K133 is only payable when the patient has one of the following conditions (listed with ministry
                                            diagnostic codes):
                                              a.Autism spectrum disorder (299)
                                              b.Intellectual disability or Fetal Alcohol Syndrome (319)
                                              c.Cerebral palsy (343)
                                              d.Spina bifida, with or without hydrocephalus, meningocele, meningomyelocele (741)
                                              e.Chromosomal anomalies such as Down’s syndrome, Fragile X syndrome, other
                                                autosomal anomalies (758)
                                          Claims submission instructions:
                                          A diagnostic code listed above that corresponds to the patient’s condition must accompany the
                                          claim for payment purposes.
                                          [Commentary:
                                          1.Guidelines relating to coordinated care and management plans can be found at: https://
                                            www.cfp.ca/content/cfp/64/4/254.full.pdf
                                          2.Unless otherwise specified in the Schedule, the calculation of time excludes (1) time devoted
                                            to any other service or procedure for which an amount is payable in addition to the periodic
                                            health visit and (2) non-patient-facing time such as such as time spent reviewing charts,
                                            imaging, or documentation, etc.]
                                   Focused practice assessment (FPA)
                                    FPA is an assessment rendered by a GP/FP physician, unless otherwise specified, with
                                    additional training and/or experience in sport medicine, allergy, pain management, sleep
                                    medicine, addiction medicine (including methadone) or care of the elderly (age 65 or older).
                                    The assessment must satisfy, at a minimum, all of the requirements of an intermediate
                                    assessment.
               A917 Sport medicine FPA ................................................................                    44.55
               A927 Allergy FPA .............................................................................              44.55
               A937 Pain management FPA...........................................................                         44.55
               A947 Sleep medicine FPA................................................................                     44.55
               A957 Addiction medicine FPA..........................................................                       44.55
               A967 Care of the elderly FPA...........................................................                     44.55

PDF page 138 / A10

CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
      Payment rules:
      1.No other consultation, assessment, visit or counselling service is eligible for payment when
        rendered the same day as one of A917, A927, A937, A947, A957 or A967 to the same patient
        by the same physician.
      2.E079 is not eligible for payment with any FPA.
      3.A957 may also be billed by a specialist with additional training and/or experience in addiction
        medicine (including methadone).
      [Commentary:
      Physicians should be prepared to provide to the ministry documentation demonstrating training
      and/or experience on request.]

PDF page 190 / A62

A680 Initial assessment – substance abuse ...................................      164.95
     Payment rules:
     1.A680 is limited to one per patient per physician or practice group except in circumstances
       where a 12 month period has elapsed since the most recent insured service rendered to the
       patient by the same physician.
     2.A680 is not eligible for payment for the assessment of substance abuse related to smoking
       cessation.
     [Commentary:
     1.For assessment services related to smoking cessation, see general listings, A957, K039 and
       E079 services, as applicable.
     2.For the purpose of A680, practice group is defined as those physicians who are part of the
       same billing group or are co-located and have shared access to the patient’s medical record.
     3.Unless otherwise specified in the Schedule, the calculation of time excludes (1) time devoted
       to any other service or procedure for which an amount is payable in addition to the
       assessment and (2) non-patient-facing time such as such as time spent reviewing charts,
       imaging, or documentation, etc.]

PDF page 195 / A67

CONSULTATIONS AND VISITS
 VIRTUAL CARE SERVICES
                    • A801 – Comprehensive midwife or Aboriginal Midwife-requested genetic
                      assessment by Video,
                 • A800 – Midwife or Aboriginal Midwife-requested genetic assessment by Video,
                 • A253 – Optometrist-Requested Assessment (ORA) by Video,
                 • A256 – Special optometrist-requested assessment by Video,
                 • A957 – Addiction medicine FPA by Video,
                 • K680 – Substance abuse – extended assessment by Video.
          [Commentary:
          1.Follow-up Virtual Care Services provided in the 24-months subsequent to the services listed
            in 3 or 4 may be claimed as Comprehensive Virtual Care Services.]
          GP Focused Practice Physician means, for the purpose of eligibility to provide a focused
          practice consultation by Video (A010, A011, A906, A913, A914), a physician who has been
          designated by the bi-lateral MOH-OMA GP Focused Practice Review Committee or a physician
          who is eligible for the focused practice psychotherapy premium.
          Limited Virtual Care Service means a Virtual Care Service rendered where an Existing/
          Ongoing Patient-Physician Relationship does not exist, and in the physicians’ professional
          opinion in accordance with accepted professional standards and practice, the person's care
          and support requirements can be effectively and appropriately delivered by Video or
          Telephone.
          Verified-Virtual Visit Solution means virtual service delivery platforms listed on Ontario
          Health’s public list of verified solutions.
          Virtual Care Service means a service provided using information technologies to render
          eligible services to patients remotely.

Master, record 336. Record Layout PDF, page 1.

A95720260401999999990000044550000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.