K683

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 192 / A64

Definition/Required elements of service:
     Monthly management of a patient in an Opioid Agonist Maintenance Program (OAMP) is the
     one month management and supervision of a patient receiving opioid agonist treatment by the
     physician most responsible for the management and supervision of that patient when rendered
     in accordance with the definitions and payment rules described below.
      This service includes the following specific elements:
         a.All medication reviews, adjusting the dose of the opioid agonist therapy, and where
           appropriate, prescribing additional therapy, and discussions with pharmacists;
          b.With the exception of all physician to physician telephone consultation services,
            discussion with, and providing advice and information to the patient, patient's relative(s),
            patient's representative or other caregiver(s), in person, by telephone or otherwise, on
            matters related to the service, regardless of identity of person initiating discussion; and
          c.All discussions in respect of the patient’s opioid dependency, except where the discussion
            is payable as a separate service.
 K682 Opioid Agonist Maintenance Program monthly management
        fee - intensive, per month...................................................                45.00
 K683 Opioid Agonist Maintenance Program monthly management
        fee - maintenance, per month ............................................                    38.00
 K684   - Opioid Agonist Maintenance Program - team premium, per
          month, to K682 or K683 ............................................. add                     6.00

PDF page 193 / A65

Definitions:
             a.Required services are:
                 i. a consultation, assessment or visit from the Consultation and Visits section of this
                      Schedule; or
                 ii. a K-prefix time-based service excluding group services and case conferences.
             b.OAMP - intensive, is the service for management of an OAMP patient receiving an opioid
               agonist where the physician renders at least two (2) required services in the month.
             c.OAMP - maintenance, is the service for management of an OAMP patient receiving an
               opioid agonist where the physician renders one required service in the month.
             d.OAMP - team premium, is the service for management of an OAMP patient receiving an
               opioid agonist where:
                 i. the physician most responsible for the OAMP management of the patient provides
                      one of K682 or K683 in the month and supervises members of the OAMP
                      management team;
                 ii. the OAMP management team consists of the physician most responsible for the
                      OAMP treatment and at least two other non-physician members who have
                      successfully completed a training program in addiction medicine that includes opioid
                      agonist management;
                 iii. the OAMP management team members provides at least one in-person therapeutic
                      encounter with the patient in the month for which the service is payable; and
                 iv. the therapeutic encounter is not primarily for the purpose of urine testing or the
                      provision of a prescription.
             e.A service primarily for the purpose of providing a prescription does not constitute a
               required service and does not count towards the minimum requirements of K682 or K683.
          Payment rules:
          1.K682, K683 and K684 are only eligible for payment to the physician most responsible for the
            patient’s OAMP for the applicable month.
          2.K684 is only eligible for payment when all required patient encounters are documented in the
            medical record.
          3.K682 is limited to a maximum of six services per patient per 12 month period.
          4.A maximum of one of K682 or K683 is eligible for payment per patient per month any
            physician.
          [Commentary:
          OAMP monthly management fees may be claimed for a patient enrolled in a treatment program
          using methadone or buprenorphine.]
          Claims submission instructions:
          Claims for K683, K682 and K684 are payable only after the minimum requirements have been
          rendered for the month.
          [Commentary:
          1.In circumstances where the physician most responsible for the patient’s OAMP is temporarily
            absent and/or the patient is transferred to another physician in any month, the physicians
            should determine who is the physician most responsible for the purposes of claim
            submission and payment. In the event that more than one claim is submitted for the same
            patient for the same month, only the first claim submitted is eligible for payment.]

PDF page 481 / J67

B. Point of care drug testing
   G041 Target drug testing, urine, qualitative or quantitative .. per test             3.70
   G042 Target drug testing, urine, qualitative or quantitative .. per test             2.50
      [Commentary:
      G041 and G042 are tests for a specific drug of abuse.]
   G040 Drugs of abuse screen, urine, must include testing for at
          least four drugs of abuse........................................ per test   15.00
   G043 Drugs of abuse screen, urine, must include testing for at
          least four drugs of abuse........................................ per test    7.50
      [Commentary:
      Drugs of abuse may include any of the following: alcohol, methadone, methadone metabolite,
      morphine, a synthetic or semi-synthetic opiate, cocaine, benzodiazepines, amphetamines,
      methamphetamines, cannabinoids, barbiturates or any other drug of abuse.]
   G039 Creatinine ............................................................................... 1.03
      Payment rules:
      1. G040 and G041 are limited to a maximum of five (5) services per patient (any combination)
        per month to any physician when K682 or K683 is payable.
          2. G042 and G043 are limited to a maximum of four (4) services per patient (any combination)
            per month to any physician when K682 or K683 is payable.
          3. Any combination of G040, G041, G042 and G043 is limited to a maximum of three (3)
            services per patient per month for management of a patient with chronic pain, an addiction,
            or receiving opioid agonist treatment program where K682 or K683 is not payable in the
            month for the same patient to any physician.
          4. G040, G041, G042 and G043 are not eligible for payment unless K623 or K624 or a
            consultation, assessment or time–based service involving a direct physical encounter with
            the patient is payable in the same month to the same physician rendering the G040, G041,
            G042 or G043 service.
          5. G039 is limited to a maximum of two (2) tests per patient per week, any physician.
          6. G039 is only eligible for payment when rendered to rule out urine tampering.
          7. Only one of G040, G041, G042 or G043 is eligible for payment per urine sample.

Master, record 3027. Record Layout PDF, page 1.

K68320250401999999990000038000000000000000000000000000000000000000000000000

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.