K125

PDF page 178 / A50

Intellectual and Developmental Disability Primary Care
     Primary care of patients with intellectual and developmental disabilities which includes any
     combination of common elements and specific elements of any insured service listed under
     “Family Practice & Practice In General” in the “Consultations and Visits” section and, in all
     cases, includes the same minimum time period requirements described for counselling in the
     General Preamble GP58. When a physician submits a claim for rendering any other
     consultation or visit to the same patient on the same day for which the physician submits a
     claim for Intellectual and Developmental Disability Primary Care, the Intellectual and
     Developmental Disability Primary Care service is included (in addition to the common
     elements) as a specific element of the other insured service. Unit means ½ hour or major part
     thereof - see General Preamble GP7, GP55 for definitions and time-keeping requirements.
 K125 Intellectual and Developmental Disability Primary Care
          ............................................................................... per unit 80.00
     Payment rules:
     K125 is only eligible for payment when the patient has Intellectual and Developmental Disability
     associated with 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.

Master, record 2967. Record Layout PDF, page 1.

K12520260401999999990000080000000000000000000000000000000000000000000000000

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.