G538

PDF page 65 / GP51

Definition/Required Elements of Service:
  Monthly Management of a Nursing Home or Home for the Aged Patient is the provision by the most
  responsible physician (MRP) of routine medical care, management and supervision of a patient in a
  nursing home or home for the aged for one calendar month. The service requires a minimum of two
  assessments of the patient each month, where these assessments constitute services described as
  "W" prefix assessments.
  The requirements above are subject to the exceptions as described in payment rule #8.
         [Commentary:
         As with all services described as assessments, direct physical encounter with the patient is
         required.]
  In addition to the common elements, this service includes the provision of the following services by
  any physician to the same patient during the month.
  A. Services described by subsequent visits (e.g. W003, W008).
  B. Services described by additional visits due to “intercurrent illness” (W121) except if the conditions
     described in Payment rule #7 are satisfied.
  C. Services described by palliative care subsequent visits (e.g. W872).
  D. Services described by admission assessments (e.g. W102, W104, W107).
  E. Services described by periodic health visit or general re-assessments (e.g. W109, W004).
  F. Services described by visit for pronouncement of death (W777) or certification of death (W771)
     except if the services are performed in conjunction with a special visit.
  G. Service described by anticoagulation supervision (G271).
  H. Completion of home care referral form and home care supervision (K070, K071, K072).
  I. Services described by the following diagnostic and therapeutic procedures – venipuncture (G489),
     injection (G372, G373), immunization (G538, G590, G849), collection of cervical cancer screening
     specimen(s) (G365, G394, E430, E431), intravenous (G379), and laboratory test codes (G001,
     G002, G481, G004, G005, G009, G010, G011, G012, G014).
  J. All medication reviews.
  K. All discussions with the staff of the institution related to the patient’s care.
  L. All telephone calls from the staff of the institution, patient, patient’s relative(s) or patient’s
     representative in respect of the patient between the hours of 0700 hours and 1700 hours Monday
     to Friday (excluding holidays).
  M.Ontario Drug Benefit Limited Use prescriptions/forms or Section 8 Ontario Drug Benefits Act
    requests.

PDF page 72 / GP58

COUNSELLING
  Definition/Required elements of service:
  Counselling is a patient visit dedicated solely to an educational dialogue with a physician. This service
  is rendered for the purpose of developing awareness of the patient’s problems or situation and of
  modalities for prevention and/or treatment, and to provide advice and information in respect of
  diagnosis, treatment, health maintenance and prevention.
                                          [Commentary:
                                          1.Advice given to a patient that would ordinarily constitute part of a consultation, assessment,
                                            or other treatment, is included as a common or constituent element of the other service, and
                                            does not constitute counselling.
       2.Detention time may be payable following a consultation or assessment when a physician is
         required to spend considerable extra time in treatment or monitoring of the patient. See
         GP29 for further information.]
  Payment rules:
    1. With the exception of the codes listed in the below, no other services are eligible for payment
       when rendered by the same physician the same day as any type of counselling service:
       E080, G010, G039, G040, G041, G042, G043, G202, G205, G365, G372, G384, G385, G394,
       G462, G480, G489, G482, G538, G590, G593, G840, G841, G842, G843, G844, G845, G846,
       G847, G848, G849, H313, K002, K003, K008, K014, K015, K031, K035, K036, K038, K682,
       K683, K684, K730
                    2. Individual and group counselling services are limited to 3 units per patient per physician per
                       year at the higher fee (K013 or K040 respectively); the amount payable for services rendered in
                       excess of this limit will be adjusted to a lesser fee (K033 or K041 respectively).
                    3. If the patient does not have a pre-booked appointment, the amount payable for this service will
                       be adjusted to a lesser assessment fee.
  A. Individual Counselling
  Definition:
  Individual counselling is counselling rendered to a single patient.
  B. Group Counselling
  Definition:
  Group Counselling is counselling rendered to two or more patients with a similar medical condition or
  situation.
  Payment rules:
     1. Group counselling is only eligible for payment when all of the following conditions are fulfilled:

PDF page 468 / J54

INJECTIONS OR INFUSIONS
                                                                                                                            Fee           Anae
                 INTRAMUSCULAR, SUBCUTANEOUS OR INTRADERMAL
               G372 - with visit (each injection) .................................................... 4.55
               G373 - sole reason (first injection) .................................................  7.90
               G372     - each additional injection................................................... 4.55
                   Note:
                   1.G372, G373 includes interpretation.
                   2.G372, G373 are not insured for vitamin injections when rendered for the purpose of
                     facilitating weight loss.
                 IMMUNIZATION
                                          [Commentary:
                                          The immunization service may not be insured under some conditions. See Appendix A for link
                                          to relevant regulation.]
                                          Note:
                                          1.Where the sole reason for the visit is to provide the immunization service add G700.
                                          2.G700 service is only payable once per patient per day.
  + G840 Diphtheria, Tetanus, and acellular Pertussis vaccine/
           Inactivated Poliovirus vaccine (DTaP-IPV) - paediatric ......                                                      8.80
  + G841 Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio
           Virus, Haemophilus influenza type b (DTaP-IPV-Hib) -
           paediatric............................................................................                             8.80
  + G842 Hepatitis B (HB) ......................................................................                              8.80
  + G843 Human Papillomavirus (HPV) .................................................                                         8.80
  + G844 Meningococcal C Conjugate (Men-C).....................................                                               8.80
  + G845 Measles, Mumps, Rubella (MMR) ..........................................                                             8.80
  + G846 Pneumococcal Conjugate.......................................................                                        8.80
  + G847 Diphtheria, Tetanus, acellular Pertussis (Tdap) - adult ...........                                                  8.80
  + G848 Varicella (VAR)........................................................................                              8.80
  + G849 Respiratory Syncytial Virus (RSV) ..........................................                                         8.80
  + G538 Other immunizing agents not listed above..............................                                               8.80
  + G590 Influenza agent .......................................................................                              8.80
  + G593 COVID-19 vaccine ..................................................................                                13.00
      INTRALESIONAL INFILTRATION
  + G375 - one or two lesions .............................................................. 10.50
  + G377 - 3 or more lesions................................................................ 15.80
    G383 - extensive (see General Preamble GP12)...........................                  I.C
        Note:
        Intralesional injection of acne lesions with corticosteroids is not an insured service.
  + G462 Administration of oral polio or rotavirus vaccine .....................                                              8.80
  + G592 Administration of intranasal influenza vaccine........................                                               1.65
    G384 Infiltration of tissues for trigger point.......................................                                     8.85
    G385    - for each additional site (to a maximum of 2) .............. add                                                 4.55

Master, record 2249. Record Layout PDF, page 1.

G53820260401999999990000008800000000000000000000000000000000000000000000000

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.