Temporary physician funding initiatives are being improved as the Ministry of Health and the Ontario Medical Association (OMA) are continuing attempts to prevent the spread of COVID-19 in Ontario. This support by the government is to provide patients with continued access to necessary health care via telephone and video calls.
Telephone or Video-Palliative Care
As of July 1st, 2021, new virtual palliative care services provided between March 14th, 2021 and September 30th, 2021, are eligible for payment.
| Fee Code | Description | Amount |
| K092A | Virtual Palliative Care Consultation-Telephone | $159.20 |
| K093A | Virtual Palliative Care Consultation-Video | $159.20 |
| K094A | Virtual Palliative Care Support-Telephone | $72.15 |
| K095A | Virtual Palliative Care Support-Video | $72.15 |
Palliative Care Fee Code Descriptions
If a patient needs specialized management for palliative care, you can use K092A (telephone) and K093A (video). Both codes require 50 minutes minimum spent consulting by video or telephone with the patient and/or their representative. Along with the general requirements for a consultation, a psychosocial assessment, comprehensive review of pharmacotherapy, appropriate counseling, and consideration of appropriate community services are also included.
If a palliative care patient needs pain and symptom management, emotional support, and counseling by video or telephone, K094A and K095A are considered palliative care support fee codes. These codes are time-based and only payable after a minimum of 20 minutes and in increments of 1/2 hour, or major part thereof. These services can be used as an extension of time for the consultation codes.
General Guidelines
- Only one of codes A945A, C945, K092A, or K093A are eligible per patient, per physician.
- ‘AC1-Max Reached-Resub ALT Fee Schedule Code’ on an error report means the limit of codes A945A, C945, K092A, or K093A was exceeded and submitted for the same patient, per physician, per year. The additional service will be rejected.
- The payment rules in the Schedule for A945A apply to the K092A (telephone) and K093A (video) consultation.
- The payment rules in the Schedule for K023A apply to the K094A (telephone) and K095A (video) support fee.
- An in-person palliative care visit cannot be billed on the same day as a virtual palliative care visit (phone or video) for the same patient. For example, when K092A is eligible for a support fee, either K094A or K095A has to be submitted. It’s implied that the virtual care visit would have covered all the required services. If an in-person palliative care visit (A945, C945, or K023) is provided the same day as a virtual palliative care visit (K092, K093, K094, or K095), claims have to be manually reviewed.
- A stale-date exemption on K092A, K093A, K094A, K095A has been applied until December 31st, 2021 for submissions for services provided near stale-dating.
Primary Care Guidelines
- K092A, K093A, K094A, and K095A will accumulate toward the Palliative Care special premium.
- The four codes are exempt from outside use.
- Family Health Group (FHG) physicians aren’t eligible to receive the 10% Comprehensive Care Premium on the K092A and K093A fee codes.
- FHG physicians are eligible to receive the 10% Comprehensive Care Premium on the K094A and K095A fee codes.
Having the option to provide patients with virtual care is convenient and accessible to both yourself and your patients. These temporary codes will allow Ontario to manage the spread of COVID ensuring everyone receives the resources they need. If you have any questions about these temporary codes, please don’t hesitate to get in touch with our team.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
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