Common Family Practice Codes as of September 1, 2011

A001 A007 A003 A004 K017 A002 A008 A888 E080 A903 K005 K007 K013 K033 K623 K022 K037 K028 K030 E079 K039 Q150 Q152 K050 K051 K052 K053 K054 K055 K056 K002 A901 A902 K023 K070 K071 K072 K032 K035 K036 K038 Minor Assessment 21.70 Intermediate Assessment 34.70 General Assessment (Dx Code 917 if Annual Health Assessment) 77.20 General Reassessment 38.35 Annual Health Exam - Child > 2 Yrs Of Age 43.60 18 Month Developmental Assessment 62.20 Mini Assessment - Billed With WSIB Minor Assess. 13.05 Emergency Dept Equivalent 35.40 First Post Hospital Premium-Within Two Weeks 25.00 Preoperative Assessment 65.05 Primary Mental Health Care 62.75 Psychotherapy 62.75 Counselling Up To 3 Units/Year 62.85 Counselling - When Billing More Than 3 Units/Yr 38.15 Form 1-Application for Psychiatric Assessment 104.80 HIV - Primary Care 62.75 Chronic Fatigue/Fibromyalgia Care 62.75 STD, BBD Mgmt-Max 2 Unit/Pat/Doc/Day & 4 Units/Pat/Doc/Yr 62.75 Diabetic Management Assessment 4 Per Year 39.20 Smoking Cessation Premium 15.40 Smoking Cessation Followup 33.45 FOBT Distribution and Counselling 7.00 FOBT Completion(see restrictions on last page) 5.00 MCFSC HSR & ADL Amalgamated Form 100.00 Health Status Report (HSR) Form 80.00 MCFSC Activities Of Daily Living (ADL) Index 20.00 Ont Works Progr. - Limit. To Participation 15.00 MCFSC Mandatory Spec. Necessities Ben. Form 25.00 MCFSC Special Diet Application Form 20.00 MCFSC Pregnancy,Breast Feeding Allowance 20.00 Application Form Interview with authorized individual 62.75 House Call Ass (1st Patient)+ Premiums 45.15 Pronounce Death In Home + Premium 45.15 Pall. Care Support-Allowable With A945>50Min 62.75 Home Care Application 31.75 Acute Home Care SupN(1/2W*12W) 21.40 Chronic Home Care SupN 1/M>12W 21.40 Neurocognitive Assessment 62.75 MTO Mandatory Reporting Medical Condition 36.25 Northern Travel Grant Application 10.25 Long Term Care Application 45.15 OBSTETRICS P006 n o P009 n o P023 n o P030 n o C989 n o P007 n o P008 n o *** E409 n o *** E410 n o *** E411 n o P004 n o P003 n o P005 n o Vaginal Delivery Attend Lab&Delivery - C-Section Oxytocin Stimulation Cervical Ripening (Max 1 Per Pregnancy) Sacrifice Office Hours Postnatal Care Hospital Postnatal Care Office Prem Days (5-12Pm), 24 Hrs Sat.Sun 50% Prem Nights Midnights-7 Am 75% Sole Del Premium 100% Minor Prenatal Assessment Major Prenatal Antenatal Preventative Assessment 498.70 498.70 67.75 58.60 76.40 55.15 34.70 249.35 374.03 498.70 34.70 77.20 45.15 5.10 11.15 25.75 44.35 12.75 4.45 9.75 29.60 29.60 20.25 37.20 20.00 30.00 45.00 34.05 11.25 11.50 15.35 6.75 9.90 21.15 25.25 20.10 4.50 4.50 3.89 6.75 8.85 13.30 8.85 4.55 25.50 92.15 58.15 33.10 6.75 6.75 11.55 39.00 20.00 35.90 8.70 11.65 9.90 7.35 3.54

no no no

SECTION ON GENERAL & FAMILY PRACTICE

150 Bloor St. West, Suite 900, Toronto, ON M5S 3C1 Tel: 1-800-268-7215 416-599-2580 ext. 3048 Fax: 416-340-2244 www.sgfp.ca E-mail address: sgfp@oma.org OHIP (Service Ontario) Information Line: 1-800-268-1153

n n n n n n n n n n n n n n n n n n n n n n n n n n n n

o o o o o o o o o o o o o o o o o

Mission Statement The Section on General & Family Practice of Ontario is the authoritative voice dedicated to enhancing the value and well being of its members and the provision of excellence in health care for patients.

o o o o o o o o o

HOSPITAL CARE C933 n o On-Call Admission Assessment 79.90 C122 n o Most Responsible Physician Day 1 58.80 C123 n o Most Responsible Physician Day 2 58.80 C124 n o Most Responsible Physician Discharge Day 58.80 E082 n o Admission assessment by the MRP, to admission assessment add 30% *E083 n o Subsequent visit by the MRP, to subsequent visit add 30% C002 n o Hospital CareSubsequent Visit for first 5 weeks 31.00 C010 n o Supportive Care 18.85 C008 n o Concurrent Care 31.00 H001 n o Newborn Care (In Hospital Or In Home) 52.20 SURGICAL ASSISTS/UNIT (X2>1 HR; X3>2.5 HRS) E400B n o Evenings Mon-Fri(5Pm To Mid.), Sat/Sun/Hol. E401B n o Nights - Midnight To 7Am. LONG TERM CARE (LTC) ONLY **W010 n o Monthly Management Fee W003 n o First 2 visits per month W008 n o Additional 2 subsequent viits per month W872 n o Palliative Care visit - no limit CCC AND CONVALESCENT CARE IN LTC W002 n o First 4 visits per month W001 n o Additional 2 Subsequent Visits - 4/month W882 n o Palliative Care visit - no limit LTC AND COMPLEX CONTINUING CARE W102 n o Admission Assessment Type 1 W107 n o Admiss Assess Type 3/readmit from acute W109 n o Annual Physical Examination W903 n o Preoperative examination (2 per year) W121 n o Intercurrent illness additional visit W777 n o Pronouncement of Death (LTC) W771 n o Cert. of Death(other HP pronounced) (LTC) K124 n o LTC Case Conf. / 10 min. unit max. 4/yr 12.04 50% 75% 108.85 32.20 21.20 32.20 32.20 21.20 32.20 69.35 30.70 70.50 65.05 31.00 34.70 20.60 31.35

OFFICE PROCEDURES + G700 n o Basic Fee > E542 n Office Premium (Tray Fee) > Z101 Abscess, Haematoma I&D (One) > Z106 n o Abscess, Ischiorectal/Pilonidal I&D G271 Anticoag Supervision G202 Allergy Inj. (1 Or More) With Visit G212 Allergy Injection Alone Z113 n Biopsy without Sutures > Z116 n Biopsy with Sutures + G370 n Injection Bursa,Jnt,Gangl,Inj/AspN Z139 n o Breast Cyst Aspiration *** Z080 n o Debride wound / ulcer to s.c tissue 10 min 1 *** Z081 n o Debride wound / ulcer to s.c tissue 10 min 2 *** Z082 n o Debride wound / ulcer to s.c tissue 10 min 3 > Z770 n o Endometrial Sampling + G420 Ear Syringe, Curette Z314 n Epistaxis - Nasal Cauterization Z315 n Epistaxis - Unil. Anterior Packing + G310 n ECG Technical G313 n ECG Professional + G403 n o Epley (BPV) Particle Repos > Z114 n Foreign Body Removal > Z104 n o Haematoma, Perianal Immunization- see pg 2 for unique codes G538 Other Immunn With Visit if sole reason add G700 G590 o Flu Shot With Visit - if sole reason add G700 G372 Injection With Visit G373 Injection-Sole Reason + G375 Intralesional Infilt -1 Or 2 Lesions + G377 3 Or More G384 Injection Trigger Point G385 Each Additional (2Max) Add > G378 n I.U.D. Insertion > R048 n Malignant Lesion-Face-single,Simple Exc > R094 n Malignant Lesion-Other-Single-Simple Exc > Z128 n Nail Resection + G365 Pap (One Yearly) + G394 n o Pap:If Prev Abnormal/Inadequate E430 n o Pap Smear Tray Fee D012 n o Pulled Elbow > Z176 Suture > Z154 n Suture: Face, Layers, Bleeders Z543 n Proctoscopy Z117 n Chem Rx Wart(Plantar,Genital) + G480 n o Venipuncture-Infant <2 Yrs Of Age + G482 Child 2-15 + G489 Adult 16+

While the SGFP has taken considerable care with the Common Family Practice Codes list as of September 1, 2011 to ensure its accuracy, it does not guarantee the accuracy of the information contained in the document. Members are advised that the ultimate authority in matters of interpretation and payments rests with the MOHLTC and, as such, members are advised to consult the Schedule of Benefits on the Ministrys website for definitive information.

LABORATORY IN GPS OFFICES G010 Urinalysis 2.07 G002 Glucose 2.18 G012 Wet Prep 1.86 G004 Stool For O.B. 1.53 G005 Pregnancy Test 3.88 G014 Rapid Strep 5.50 Pulmonary Function J301 n Simple Spirometry-$7.85P,$9.55T 17.40 J324 n --Repeat After Bronchodilator-$4.20P,2.88T 7.08 J304 n Flow Volume Loop-$10.75P, $19.05T 29.80 J327 n -- Repeat After Bronchodilator-$6.45P,$2.88T 9.33 New requirements re PFTs-check SOB Commentary-page H3

* E083 applies to C002, C007, C009, C122, C123, C124, C142, C143, C882 or C982 **If you are billing the W010 monthly LTC code, the following services are included in the code and may not be billed as separate services: W003; W008; W121; W872; W102; W104; W107; W903; W109; W004; W777; W771; G271; K070; K071; K072; G489; G372; G373; G538; G590; G365; G394; E430; G379; G001; G002; G481; G003; G004; G005; G006; G007; G008; G009; G010; G011; G012 & G014

***Dollar Value Calculated For P006 ***More new Z codes can be found in the Schedule of Benefits Changes introduced on September 1, 2011 are highlighted in red

> E542 may be charged with these fees + add G700 to these fees if sole reason for visit n common fees outside the FHN basket o common fees outside the FHO basket

Special Visit Premiums

Maximum Patients HOME VISIT PREMIUMS B990 n 27.50 Daytime Mon-Fri (07:00-17:00)/Elective Home Visit 10 B992 n 44.00 Sacrifice Office Hours 10 B994 n 66.00 Evenings Mon-Fri (17:00-24:00) 10 B993 n 82.50 Sat, Sun, Holidays (07:00-24:00) 20 B996 n 110.00 Night(00:00-07:00) Every Day no limit B997 n o 110.00 Palliative Care Patient Night (00:00-07:00) no limit B998 n o 82.50 Palliative Care Patient (All other Times) no limit OFFICE VISIT PREMIUM For other non-professional sites substitute Q for A A990 20.00 Day (0700-1700) Mon-Fri A994 60.00 Evenings Mon-Fr (17:00-24:00) A998 75.00 Sat, Sun, Holidays (07:00-24:00) A996 100.00 Night (00:00-07:00) Every Day HOSP PREM C=HOSP,K=ER,U=OPD,W=LTC Substitute Appropriate Site Prefix for C C990 n o 20.00 Day (07:00-17:00) Mon-Fri C992 n o 40.00 Sacrifice Office Hours C994 n o 60.00 Evenings Mon-Fri, (17:00-24:00) C986* n o 75.00 Sat, Sun, Holidays (07:00-24:00) C996 n o 100.00 Night (00:00-07:00) Maximum Travel Additional Patient Travel Premium

Emergency Room Codes

ER D=DAY W=HOLI&WKND E=EVE N=NIGHT A100 D H102 H103 H101 H104 W H152 H153 H151 H154 E H132 H133 H131 H134 H105 N H122 H123 H121 H124 G521 n n n n n n n n n n n n n n n n n n n o o o o o o o o o o o o o o o o o o o Family Physician Er Department Ass 76.90 Comprehensive Assessment 37.20 Multiple Systems Assessment 35.65 Minor Assessment 15.00 Reassess 15.00 Comprehensive Assessment 63.30 Multiple Systems Assessment 56.95 Minor Assessment 25.50 Reassess 25.50 Comprehensive Assessment 46.30 Multiple Systems Assessment 42.40 Minor Assessment 18.70 Re-Assessment 18.70 Inpatient Interim Orders 26.25 Comprehensive Assessment 73.90 Multiple Systems Assessment 65.95 Minor Assessment 29.80 Reassess 29.80 Life threatening emergency situation-first 1/4 hr 110.55 Life threatening emergency situation-2nd 1/4 hr 55.20 after 1st half hour per 1/4 hr 36.35 Other resuscitation-first 1/4 hour 56.80 Other resuscitation-after first 1/4 hour 28.35

ADD TRAVEL PREMIUM 36.40 2 visit fee B960 2 visit fee B961 2 visit fee B962 6 visit fee B963 no limit visit fee B964 no limit no limit B966 no limit no limit B966 ADD TRAVEL PREMIUM 36.40 1 visit fee A960 1 visit fee A962 1 visit fee A963 no limit A964 ADD TRAVEL PREMIUM 36.40 2 C991 C960 2 C993 C961 2 C995 C962 6 C987* C963 no limit C997 C964

1 1 1 no limit

10 10 10 20 no limit

G523 n o G522 n o G395 n o G391 n o

*Please note that the numbers C986 and C987 apply only to the C codes because C998 and C999 were already assigned assigned to Surgical Assistants. For all other letters i.e. A, B, K, U & W the numbers remain 998 and 999.

Evening and Night Procedure Premiums E412 Prem evngs (5-12mid) 24 Sat. Sun. Hol. Prem nights (12mid-7a.m.) add 20% add 40%

Geriatric Premiums
The amount payable for the following services to an insured person who is at least 65 years of age increases by 15%: (A003, A903, C003, W102, W109, or W903) (A004, C004, W004) (A007) (A901) (A917, A927, A937, A947, A957 or A967)

E413

n common fees outside the FHN basket o common fees outside the FHO basket Changes introduced on September 1, 2011 are highlighted in red.

Immunization Codes
G840 G841 G842 G843 G844 G845 G846 G847 G848 G538 G590 Quadracel Pediacel Hepatitis B HPV type 6, 11,16, 18 (Gardasil) Menjugate (men C) MMR, Priorix Prevnar 13 Adacel, Boostrix Varicella (Varilrix, Varivax) Other immunizing agents o Influenza 4.50 4.50 4.50 4.50 4.50 4.50 4.50 4.50 4.50 4.50 4.50 5.10

Telephone Consultation Codes

Physician to PhysicianTelephone/ Critical Telephone Consultation Fees Minimum 10 minutes. (1) (2) (3) Type and/or Location of Call Ofce or Other Locations Emergency/ Hospital Urgent Care Clinic Criticall Referring Physician Consulting Physician $31.35 $40.45 K730 One/ patient/day K734 One/patient/day K732* Two/patient/day K736* Two/patient/day K731 one/patient/ day K735 one/patient/day K733* One/md/pat/day K737* One/md/pat/day

G700 n o If sole reason is immunization or flu shot add

Note: For ER codes the injection fee for G372A and G373A has not changed. n common fees outside the FHN basket o common fees outside the FHO basket Changes introduced on September 1, 2011 are highlighted in red.

Crticall Emergency/ Hospital Urgent Care Clinic

(1) Codes are in the basket for FHN, FHO and GHC capitated models. (2) Codes are eligible for the shadow billing premium with the FHN. (3) Call time per patient can be cumulative over one day.

*No time restrictions Review SOB preamble for detailed payment rules. Three K733 or K737 (any combo)/patient/day.

Diagnostic Codes
Abdominal Pain Abortion (incomplete) Abortion(Therapeutic) Abortion(Threatened) Abrasions, Contusions Abscess(Skin) Acne Adenitis Adjustment reaction Adverse Drug Reaction AIDS Alcoholism Alopecia Amenorrhea Anemia (aplastic) Anemia (Iron Defic) Anemia (Pernicious) Angina Ankle Strain Anorexia Anxiety Appendicitis Apthous Ulcer Arrythmia Arteriosclerosis ArteritisTemporal Arthritis(Osteo) Arthritis(Rheumatoid) ASHD Asthma Astigmatism Ataxia Athletes foot Back Pain Bakers Cyst Balanitis Basal Cell Ca Behaviour Disorder Biliary Colic Birth Control Bite (Animal) Bite (Insect) Bleeding (Post Menop) Bleeding (rectal) Blepharitis Blocked Tear Duct Boil BPH Breast Abscess Breast Cancer Breast Disorder Breast Lump(benign) Bronchitis (chronic) Bronchitis Acute Bunions Burns Bursitus Calculus (biliary) Cancer Cervix Cancer Prostate Cancer Uterus Candidiasis Cardiac Arrest Carpal Tunnel Syndrome Cataracts Cellulitus Cervical Disc Disease Cervical Erosion/dysplas Cervicitis Chalazion Chest Pain Chicken Pox Chlamydia Cholelithiasis Cirrhosis Coccydynia Colon Cancer Colon Family History of Colon Cancer 787 634 640 640 919 685 706 289 309 977 042 303 704 626 284 280 281 413 845 787 300 540 528 427 440 441 715 714 412 493 367 780 110 847 739 608 173 313 574 895 919 959 627 569 373 375 680 600 611 175 611 217 491 466 727 949 727 576 180 185 182 112 427 739 366 682 847 622 622 373 785 052 099 574 571 774 153 547 Colon Positive Fecal occult blood Colon Screening Colon Surveillance Concussion Condylomata Congestive Heart Failure Conjunctivitis Constipation Contraception Contusion COPD Corneal Ulcer Cough Corns, Calluses Coronary Artery Disease Crohns disease Croup CVA Cystitis Cystocoele Deafness Dementia Dental Abscess Dental Caries Depression Dermatitis (Contact) Dermatitis (Seborrhea) Deviated Nasal Septum Diabetes Diaper Rash Diarrhea Disc Disease Diverticulitis Divorce Dizziness Drug Dependence Drug Reaction DVT Dysmenorrhea Dyspareunia Dyspepsia Dysphagia Dyspnea Eczema Edema Emphysema Endometriosis Enuresis Epididymo-orchitis Epilepsy Epistaxis Esophagitis Exhaustion Failure to Thrive Family Planning Fatigue Feeding Problem(Infant) Fever Fibroids Fibrositis Fissure in ano Flatfeet Flu Food Poisoning Foreign Body Fractured Finger Frequency Frostbite Frozen Shoulder Fungal Infection Furunculosis Gall Stone Ganglion Gangrene Gastric Ulcer Gastritis Gastroenteritis Gastrointestinal Gingivitis 545 548 546 850 629 428 372 564 895 919 491 370 786 700 412 555 464 436 595 618 389 290 525 521 311 692 690 470 250 692 009 722 562 901 780 304 977 451 625 625 536 787 786 691 785 492 617 307 604 345 786 530 796 799 895 796 799 796 218 729 565 734 487 005 930 816 788 944 729 117 680 574 727 442 531 535 009 787 523 Glaucoma Glossitis Goitre Gout Grief Reaction Gynecomastia Hair Loss Hallux Valgus Head Injury Headache NYD Headache(Migraine) Headache(Tension) Heart Failure Heart Murmur Heartburn Hemangioma Hematoma Hematuria Hemiplegia Hemoptysis Hemorrhoids Hepatitis Hernia (Inguinal) Hernia(other) Herpes Genitalis Herpes Simplex Herpes Zoster HIV Hives Hydrocele Hyperactivity Hypercholesterolemia Hyperemesis Hypertension Hypertensive Heart Hyperthyroid Hyperventilation Hypothyroid Hysteria Immunization Impetigo Impotence Incontinence Indigestion Infertility (Female) Infertility(male) Influenza Ingrown Toe Nail Insect Bite Insomnia Intertrigo Iritis Irritable Colon Jaundice Joint Pain Keloid Keratitis Keratosis Kidney Stone Knee Pain Labyrinthitis Laceration Lower Laceration Other Laceration Upper Laryngitis Leg Cramps Legal Problems Leukorrhea Lipoma Liver Disease (other) Low Back Pain Lupus Lymphangitis Malaise Marital Problems Mastitis (Abscess) Mastitis (Cystic) Measles Melena Meniscal tear 365 529 240 274 300 611 704 735 854 780 346 307 428 429 787 228 959 599 349 786 455 070 550 553 099 054 053 279 708 603 314 272 643 401 402 242 786 244 300 896 684 306 599 536 628 606 487 703 919 307 695 364 564 787 781 701 370 701 592 844 386 894 879 884 464 781 906 629 214 573 724 695 457 799 898 611 610 055 787 718 Menopause Menorrhagia Menstrual Disorder Mental Retardation Migraine Miscarriage Mitral Valve Prolapse Mole Mononucleosis Multiple Sclerosis Mumps Muscle Spasm Myopia Nausea or Vomiting Nephritis Neuralgia (Trigeminal) Neuritis Nevus Nevus (Pigmented) Nosebleed Obesity Occupational Problem Oral Ulcers Osteoarthritis Osteomyelitis Osteoporosis Otitis Externa Otitis Media Ovarian Cyst Overdose Pain (chest) Pain(joint,leg,muscle) Pancreatitis Parkinsons Paronychia PAT Pediculosis Pelvic Inflammatory Dis Peripheral Vascular Dis Personality disorder Pharyngitis Phimosis Phlebitis Pilonidal Abscess Pinworms Pleurisy Pnuemonia Poison Ivy, Oak Polymyalgia rheumatic Poliomyelitis Pregnancy (ectopic) Pregnancy (normal) Prolapse Uterus Prostate Cancer Prostate Hypertrophy Prostatis Pruritus Psoriasis Pulmonary embolism Pyelonephtitis Pyrexia Pyuria Rash Raynauds Phenomenon Rectal Bleeding Reflux Esophagitis Renal Calculi Renal Colic Renal Failure Rheumatoid Arthritis Rhinitis Ringworm (scalp, beard) Ringworm(other) Rosacea Rubella Scabies Scarring Schizophrenia Sciatica Scoliosis 627 626 626 319 346 634 429 216 075 340 072 728 367 787 580 350 356 216 709 786 278 905 528 715 730 733 380 381 220 977 785 781 577 332 686 427 132 614 443 301 460 605 451 682 127 511 486 692 725 045 633 650 621 185 600 601 698 696 459 590 796 599 691 443 569 530 592 788 584 714 477 110 117 695 056 133 709 295 724 737 Sebaceous Cyst Seborrhea Seizure Disorder Senility Sexual Dysfunction Shingles Shortness of Breath Sickle Cell Sinusitus Sinusitus (acute) Sinusitus (chronic) Sleep Disorder Smoking Cessation Social Maladjustment Sprain (Foot, ankle) Sprain (Leg, Knee) Sprain (lumbar) Sprain (Neck) Sprain(Shoulder) Sprain (Wrist) Sprain, Strain (Other) STD Stomatitis Strabismus Strep Throat Stress incontinence Stroke Stye Sunburn Syncope Tachycardia TB test, conversion Tendonitis Tennis elbow Tenosynovitis Tension Headache Threatened Abortion Thrush Thyroiditis Thyrotoxicosis Tinnitus TIA Tonsillitis Toothache Torticollis Tracheitis Trichomonas Trigger Finger Ulcer (duodenal) Ulcer (Gastric) Undescended testicle URI Uremia Urethral Stricture Urethritis Urinary Infection Urticaria Ulcerative Colitis Umbilical Hernia Unemployment Vaginal Bleeding Vaginitis Varicose Vein, ulcer Vasovagal attack Venereal Disease Vertigo Viral illness Viral Rash Vomiting Vulvitus Warts Wax Weight Loss Well Baby Visit Whiplash Whooping Cough Wound Infection Wry Neck Yeast Vaginitis 706 690 345 797 306 053 786 282 461 461 473 307 491 904 845 844 724 847 840 842 848 099 528 378 034 625 436 373 691 785 427 010 727 739 727 307 640 112 245 242 388 435 463 525 739 464 131 727 532 531 608 460 585 598 597 599 708 556 553 905 626 616 454 780 099 780 079 057 787 616 078 388 796 916 847 033 998 733 616

Patient Enrolled Models Q Codes

Commonly Billed Q Codes
Q200A *Q013A Q023A *Q033A **Q043A ***Q053A Q054A Q055A Q056A Q057A Q150A Q050A Q040A Q042A

Preventive Care Tracking Codes

(Enrolled Patients Only) Q130A Influenza Vaccine over 65 Q011A Pap 35-69 Q131A Mammogram 50-69 Q132A Immunization 18-24 Months Q133A Colorectal Screening 50-74 Exclusion Code: (Improves efficiency when calculating yearly bonus payments) Q140A Pap 35-69 Q141A Mammogram 50-69 Q142A Colorectal Screening 50-74

CCM,FHG,FHN & FHO (all models):

Enrollment Fee (first year only) $5.00 New patient premium max 60/year $100-$180 Unattached pt. fee, from hospital, no max $150 New Grad. New pt. fee (max 300,first year only) $100-$180 New Pt. fee FOBT +/Colorectal increased risk $150-230 HCC Complex vulnerable new patient $350.00 Unattached mother/newborn (<2 weeks from birth) $350.00 Unattached newborn,multiple births, each baby $150.00 HCC Upgrade Patient Status $850.00 HCC Greater than 3 months $200.00 FOBT Distribution and Counselling Fee $7 Heart Failure Management Incentive $125 Diabetes Management incentive - Annual Flow Sheet $75/yr Smoking Cessation Counselling Fee $7.50

Preventive Care Management Fees

FHN and FHO only For billing rules go to: http://www.oma.org/PC/fhn/FHNGeneralBlendedTemplatev02.01.pdf Q001A Pap $6.86 Q002A Mammogram $6.86 Q003A Influenza vaccine (>65 years). $6.86 Q004A Childhood immunizations (18-24 months) $6.86 FHN, FHO, FHG & CCM Q005A Colorectal Screening 50-74 $6.86

FHG, FHN and FHO only:

Primary Care Serious Mental illness Bi-polar Q020A Schizophrenia Diagnostic Code 295 5-9 patients - $1000/yr 10+ patients - $2000/yr Q012A After 5pm,W/E, holiday add-on Q555A Q556A

30% $25/15 min $25/15 min

Preventive Care Service Enhancement Fees

FHN, FHO, FHG & CCM Paid annually based on percentage of enrolled patients serviced Influenza vaccine Q100A 60% $220.00 Q101A 65% $440.00 Q102A 70% $770.00 Q103A 75% $1,100.00 Q104A 80% $2,200.00 Pap Smear Q105A 60% $220.00 Q106A 65% $440.00 Q107A 70% $660.00 Q108A 75% $1,320.00 Q109A 80% $2,200.00 Mammogram Q110A 55% $220.00 Q111A 60% $440.00 Q112A 65% $770.00 Q113A 70% $1,320.00 Q114A 75% $2,200.00 Childhood Immunizations Q115A 85% $440.00 Q116A 90% $1,100.00 Q117A 95% $2,200.00 Colorectal Screening Q118A 15% $220.00 Q119A 20% $440.00 Q120A 40% $1,100.00 Q121A 50% $2,200.00 Q122A 60% $3,300.00 Q123A 70% $4,000.00 APPLIES TO FFS OR PATIENT ENROLLED MODEL WITH LESS THAN MAXIMUM ROSTER SIZE as per Q152 on front page Q152 FOBT completion fee

FHN and FHO automated claims:

Mainpro C Mainpro M1 Note: CME in 15 min increments.

FHN only:
Q014A Newborn Episodic Care (<1year old, max 8) $15.05

FHO only:
Q015A Newborn Episodic Care (<1year old, max 8) $13.99

FHG only:

FHGs-10% premium automatically added to A001, A002, A003, A007,A008,A888,A901,A902,C010,C882,G365,G538, G590,K005, K013, K017,K022,K023,K030

CCM only:
Q016A

After 5pm, W/E holiday add-on

30%

Q012 (FHG, FHN, FHO) and Q016 (CCM) apply to: A001A, A003A, A004A, A007A, A008A, A888A, K005A, K013A, K017A, K030A, K033A, Q050A *Q013A & Q033A New patients over 75 - $180, New patients over 64 - $120 Patients up to 64 - $100 **Q043A Patients 75 years and over - $230, Patients over 64 - $170 Patients up to 64 - $150 ***Q053 Same payment regardless of age. Requires patient be registered with Health Care Connect. No maximum number

$5

For further information on CCMs, FHGs, FHNs and FHOs, you may access the OMA Primary Care Renewal Tutorials at https://www.oma.org/Member/Resources/PrimaryCareModels/Pages/default.aspx or contact your Primary Health Care Team Ministry Site at 1-866-766-0266

Copyright 2011 SGFP