K121

PDF page 161 / A33

CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
    Hospital in-patient case conference
      In addition to the definitions, required elements, payment rules, medical record requirements in
      the Preamble - Case conferences, a hospital in-patient case conference is participation by the
      physician most responsible for the care of the patient and at least 2 other participants that
      include physicians, regulated social workers and/or regulated health professionals regarding a
      hospital in-patient.
   K121 Hospital in-patient case conference............................ per unit            37.05
       Payment rules:
       1.K121 is eligible for payment for a case conference regarding a hospital in-patient at an acute
         care hospital, chronic care hospital, or rehabilitation hospital. K121 is not eligible for payment
         for a resident in a long term care institution.
          2.K121 is limited to a maximum of 4 services per patient, per physician, per 12 month period.
          3.A maximum of 8 units of K121 are payable per physician, per patient, per day.
          4.K121 is not eligible for payment for radiation treatment planning services listed in the
            Radiation Oncology section of this Schedule.
          5.Services described in the supervision of postgraduate medical trainees section of this
            Schedule are not eligible for payment as K121.
          [Commentary:
          1.For case conferences regarding out-patients, see K700, K701, K702, K703, K704 and K707
            for applicable services.
          2.For case conferences regarding an in-patient in a long term care institution, see K124.]
        Palliative care out-patient case conference
         In addition to the definitions, required elements, payment rules, medical record requirements in
         the Preamble - Case conferences, a palliative care out-patient case conference is participation
         by the physician most responsible for the care of the patient and at least 2 other participants
         that include physicians, regulated social workers and/or regulated health professionals
         regarding a palliative care out-patient.
   K700 Palliative care out-patient case conference ................ per unit         37.05
       Payment rules:
       1.K700 is only eligible for payment for case conference services regarding a palliative care out-
         patient.
          2.No other case conference or telephone consultation service is eligible for payment with K700
            for the same patient on the same day.
          3.K700 is limited to a maximum of 4 services per patient, per physician, per 12 month period.
          4.A maximum of 8 units of K700 are payable per physician, per patient, per day.
          5.K700 is not eligible for payment for radiation treatment planning services listed in the
            Radiation Oncology section of this Schedule.
          [Commentary:
          1.For definitions related to palliative care, see General Definitions in the General Preamble of
            the Schedule.
          2.For case conferences regarding an in-patient in an acute care hospital, chronic care hospital,
            or rehabilitation hospital, see K121.
          3.For case conferences regarding an in-patient in a long term care institution, see K705 or
            K124.]

PDF page 162 / A34

CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
   Paediatric out-patient case conference
    In addition to the definitions, required elements, payment rules, medical record requirements in
    the Preamble - Case conferences, a paediatric out-patient case conference is participation by
    the physician most responsible for the care of the patient with at least 2 other participants that
    include physicians, regulated social workers regulated health professionals, education
    professionals, and/or personnel employed by an accredited centre of Children's Mental Health
    Ontario, regarding an out-patient less than 18 years of age.
 K704 Paediatric out-patient case conference ...................... per unit         37.05
     Payment rules:
     1.No other case conference or telephone consultation service is eligible for payment with K704
       for the same patient on the same day.
     2.K704 is limited to a maximum of 4 services per patient, per physician, per 12 month period.
     3.A maximum of 8 units of K704 are payable per physician, per patient, per day.
     4.K704 is only eligible for payment when the physician most responsible has a specialty
       designation in Paediatrics (26) or Psychiatry (19).
     [Commentary:
     1.For case conferences regarding an in-patient in an acute care hospital, chronic care hospital,
       or rehabilitation hospital, see K121.
     2.For case conferences regarding an in-patient in a long term care institution, see K705 or
       K124.
     3.K704 is eligible for payment to physicians other than those who are specialists in Paediatrics
       (26) or Psychiatry (19) as long as the physician most responsible is a paediatrician or
       psychiatrist.
     4.For a list of mental health centres accredited by Children's Mental Health Ontario, see the
       following link: https://cmho.org/our-members/.]
   Mental health out-patient case conference
    In addition to the definitions, required elements, payment rules, medical record requirements in
    the Preamble - Case conferences, a mental health out-patient case conference is participation
    by the physician most responsible for the care of the patient with at least 2 other participants
    that include physicians, regulated social workers, regulated health professionals, and/or
    personnel employed by a mental health community agency funded by the Ontario Ministry of
    Health, regarding an adult out-patient.
 K701 Mental health out-patient case conference................. per unit            37.05
     Payment rules:
     1.No other case conference or telephone consultation service is eligible for payment with K701
       for the same patient on the same day.
     2.K701 is limited to a maximum of 4 services per patient, per physician, per 12 month period.
     3.A maximum of 8 units of K701 are payable per physician, per patient, per day.
     4.K701 is only eligible for payment when the physician most responsible has a specialty
       designation in Psychiatry (19).
     [Commentary:
     1.For case conferences regarding an out-patient aged less than 18 years of age, see K704.
     2.For case conferences regarding an in-patient in an acute care hospital, chronic care hospital,
       or rehabilitation hospital, see K121.

PDF page 164 / A36

CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
   Bariatric out-patient case conference
     In addition to the definitions, required elements, payment rules, medical record requirements in
     the Preamble - Case conferences, bariatric out-patient case conference is participation by the
     physician most responsible for the care of the patient with at least 2 other participants that are
     working at a Bariatric Centres of Excellence (BCoE) or a Bariatric Regional Assessment and
     Treatment Centre (RATC) and include physicians, regulated social workers and/or regulated
     health professionals regarding an out-patient registered with a BCoE or a Bariatric RATC for
     the purpose of pre-operative evaluation and/or post-operative follow-up medical care.
 K702 Bariatric out-patient case conference ......................... per unit         37.05
     Payment rules:
     1.K702 is only eligible for payment when rendered for a patient registered in a BCoE or a
       Bariatric RATC.
      2.K702 is only eligible for payment for physicians identified to the ministry as working in a
        BCoE or a Bariatric RATC.
      3.No other case conference or telephone consultation service is eligible for payment with K702
        for the same patient on the same day.
      4.K702 is limited to a maximum of 4 services per patient, per physician per 12 month period.
      5.A maximum of 8 units of K702 are payable per physician, per patient, per day.
      [Commentary:
      1.For the definitions of a BCoE and/or a Bariatric RATC, see Definitions in the General
        Preamble.
      2.For case conferences regarding an in-patient in an acute care hospital, chronic care hospital,
        or rehabilitation hospital, see K121.
      3.For case conferences regarding an in-patient in a long term care institution, see K124.]
   Geriatric out-patient case conference
     In addition to the definitions, required elements, payment rules, medical record requirements in
     the Preamble - Case conferences, geriatric out-patient case conference is participation by the
     physician most responsible for the care of the patient with at least 2 other participants that
     include physicians, regulated social workers and/or regulated health professionals regarding
     an out-patient who is at least 65 years of age or, a patient less than 65 years of age who has
     dementia.
 K703 Geriatric out-patient case conference......................... per unit          37.05
     Payment rules:
     1.K703 is not eligible for payment with any other case conference or telephone consultation
       service for the same patient on the same day.
      2.K703 is limited to a maximum of 4 services per patient, per physician, per 12 month period.
      3.A maximum of 8 units of K703 are payable per physician, per patient, per day.
      4.K703 is only eligible for payment to:
         a.a specialist in Geriatrics (07); or
         b.a physician with an exemption to access bonus impact in Care of the Elderly from the
            MOH.
      [Commentary:
      1.For case conferences regarding an in-patient in an acute care hospital, chronic care hospital
        or rehabilitation hospital, see K121.
      2.For case conferences regarding an in-patient in a long term care institution, see K124.]

PDF page 165 / A37

CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
        Chronic pain out-patient case conference
         In addition to the definitions, required elements, payment rules, medical record requirements in
         the Preamble - Case conferences, chronic pain out-patient case conference is participation by
         the physician most responsible for the treatment of the patient`s chronic pain with at least 2
         other participants that include physicians, regulated social workers and/or regulated health
         professionals regarding an out-patient.
   K707 Chronic pain out-patient case conference .................. per unit         37.05
       Payment rules:
       1.K707 is not eligible for payment with any other case conference or telephone consultation
         service for the same patient on the same day.
          2.K707 is limited to a maximum of 4 services per patient, per physician, per 12 month period.
          3.A maximum of 8 units of K707 are payable per physician, per patient, per day.
          [Commentary:
          1.For case conferences regarding an in-patient in an acute care hospital, chronic care hospital
            or rehabilitation hospital, see K121.
          2.For case conferences regarding an in-patient in a long term care institution, see K124.
          3.Chronic pain is defined as a pain condition with duration of symptomatology of at least 6
            months.]

PDF page 166 / A38

CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
   Long-term care/Ontario Health atHome case conference
    In addition to the definitions, required elements, payment rules, medical record requirements in
    the Preamble - Case conferences, a long-term care/Ontario Health atHome case conference is
    participation by the physician most responsible for the care of the patient and at least 2 other
    participants that include physicians, regulated social workers, employees of a Ontario Health
    atHome and/or regulated health professionals regarding a long-term care institution inpatient.
 K124 Long-term care/Ontario Health atHome case conference . per
        unit                                                                             37.05
     Payment rules:
     1.K124 is limited to a maximum of 4 services per patient, per physician, per 12 month period.
     2.A maximum of 8 units of K124 are payable per physician, per patient, per day.
     3.K124 is not eligible for payment for radiation treatment planning services listed in the
       Radiation Oncology section of this Schedule.
     4.Services described in the supervision of postgraduate medical trainees section of this
       Schedule are not eligible for payment as K124.
     [Commentary:
     1.For case conferences regarding out-patients, see K700, K701, K702, K703, K704, and K707
       for applicable services.
     2.For case conferences regarding an in-patient in an acute care hospital, chronic care hospital
       or rehabilitation hospital, see K121.]
   Long-term care – High risk patient case conference
    In addition to the definitions, required elements, payment rules, medical record requirements in
    the Preamble - Case conferences, a Long-term care – High risk patient case conference is
    participation by a physician and at least 2 other participants that include physicians, employees
    of Ontario Health atHome, regulated social workers and/or regulated health professionals
    regarding a long-term care institution high risk inpatient.
 K705 Long-term care – high risk patient conference ........... per unit            37.05
     Payment rules:
     1.K705 is limited to a maximum of 4 services per patient, per physician, per 12 month period.
     2.A maximum of 8 units of K705 are payable per physician, per patient, per day.
     3.K705 is not eligible for payment for radiation treatment planning services listed in the
       Radiation Oncology section of this Schedule.
     4.Services described in the supervision of postgraduate medical trainees section of this
       Schedule are not eligible for payment as K705.
     Note:
     1.In circumstances where the physician other than the physician most responsible for the care
       of the patient participates in the case conference, K705 is only eligible for payment when the
       physician’s participation is for directing the care of the individual patient.
     2.For the purposes of K705, a high risk patient is a patient identified by staff in the long term
       institution with clinical instability based on a change in the Resident Assessment Instrument –
       Minimum Data Set (RAI-MDS) for Nursing Homes.

PDF page 167 / A39

CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
          [Commentary:
          1.For case conferences regarding out-patients, see K700, K701, K702, K703, K704, and K707
            for applicable services.
          2.For case conferences regarding an in-patient in an acute care hospital, chronic care hospital,
            or rehabilitation hospital, see K121.
          3.For case conferences regarding an in-patient in a long term care institution, other than a
            patient meeting the definition of a K705 service, see K124.
          4.The Resident Assessment Instrument – Minimum Data Set (RAI-MDS) for Nursing Homes
            can be found at the following link: https://www.cms.gov/NursingHomeQualityInits/
            20_NHQIMDS20.asp.]

PDF page 168 / A40

CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
    Convalescent care program case conference
     In addition to the definitions, required elements, payment rules, medical record requirements in
     the Preamble - Case conferences, a convalescent care case conference is participation by the
     physician most responsible for the care of the patient and at least 2 other participants that
     include physicians, regulated social workers, employees of the Convalescent Care Program
     and/or regulated health professionals regarding a patient enrolled in a Convalescent Care
     Program funded by the MOH.
 K706 Convalescent care program case conference ........................            37.05
     Payment rules:
     1.K706 is limited to a maximum of 8 services per patient, per physician, per 12 month period.
     2.A maximum of 4 units of K706 are payable per physician, per patient, per day.
     3.Services described in the supervision of postgraduate medical trainees section of this
       Schedule are not eligible for payment as K706.
     [Commentary:
     1.For case conferences regarding out-patients, see K700, K701, K702, K703, K704 and K707
       for applicable services.
     2.For case conferences regarding an in-patient in an acute care hospital, chronic care hospital,
       or rehabilitation hospital, see K121.
     3.For case conferences regarding an in-patient in a long term care institution, see K705 or
       K124.]
   Multidisciplinary Respiratory Case Conference
     In addition to the definitions, required elements, payment rules, medical record requirements in
     the Preamble - Case conferences, a multidisciplinary respiratory case conference is
     participation by the physician most responsible for the care of the patient and at least 2 other
     participants that include physicians, regulated social workers and/or regulated health
     professionals regarding a patient with interstitial lung disease.
 K715 Multidisciplinary respiratory case conference .........................         37.05
     Payment rules:
     1.K715 is limited to a maximum of 4 services per patient, per physician, per 12 month period.
     2.A maximum of 8 units of K715 are payable per physician, per patient, per day.
     3.Services described in the supervision of postgraduate medical trainees section of this
       Schedule are not eligible for payment as K715.
     [Commentary:
     1.For case conferences regarding out-patients, see K700, K701, K702, K703, K704 and K707
       for applicable services.
     2.For case conferences regarding an in-patient in an acute care hospital, chronic care hospital,
       or rehabilitation hospital, see K121.
     3.For case conferences regarding an in-patient in a long term care institution, see K705 or
       K124.]

PDF page 169 / A41

CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
     Multidisciplinary Epilepsy Surgery Case Conference
       In addition to the definitions, required elements, payment rules, medical record requirements in
       the Preamble - Case conferences, a multidisciplinary epilepsy surgery case conference is
       participation by the physician most responsible for the care of the patient and at least 2 other
       participants that include physicians, regulated social workers and/or regulated health
       professionals regarding a patient who may be a candidate for epilepsy surgery.
   K714 Multidisciplinary epilepsy surgery case conference................              37.05
       Payment rules:
       1.K714 is limited to a maximum of 4 services per patient, per physician, per 12 month period.
          2.A maximum of 8 units of K714 are payable per physician, per patient, per day.
          3.Services described in the supervision of postgraduate medical trainees section of this
            Schedule are not eligible for payment as K714.
          [Commentary:
          1.For case conferences regarding out-patients, see K700, K701, K702, K703, K704 and K707
            for applicable services.
          2.For case conferences regarding an in-patient in an acute care hospital, chronic care hospital,
            or rehabilitation hospital, see K121.
          3.For case conferences regarding an in-patient in a long-term care institution, see K705 or
            K124.]

Master, record 2963. Record Layout PDF, page 1.

K12120260401999999990000037050000000000000000000000000000000000000000000000

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.