The Minister of Health has made an Order under the authority of subsection 45(2.1) of the Health Insurance Act to list temporary new fee codes to support the government’s vaccine strategy and roll out.
Temporary Fee Code G593
As of March 6th, 2021, if you provide the COVID-19 vaccine in a setting not designated by the Ministry of Health as a COVID-19 Assessment Centre, you can bill temporary fee code G593 for $13.
Guidelines
- When multiple doses are necessary to complete the vaccination series, G593 is payable for each dose.
- G593 is not payable for booster COVID-19 vaccination doses.
- G593 is payable in combination with other insured services on the same day to the same patient, excluding H409/H410.
- If the vaccine is the primary purpose for the visit, G700 is also payable.
- If your patient doesn’t have a valid health card but is OHIP insured, process the service as you would for invalid health cards.
- If your patient’s health card is expired, refer to INFOBulletin 201107 and follow existing health card validation services.
Uninsured Patients
If your patient is uninsured (international student or out-of-province patient) and you provide the COVID-19 vaccine in a primary care setting, you’ll have to contact the Ministry to claim the service. Be sure to have your ID, your patient’s surname, first name, date of birth, and address. If eligible, you’ll receive a manual payment according to the relevant fee schedule codes.
Primary Care Contracts
As of March 6th, 2021, temporary fee code Q593 ‘sole visit premium COVID-19 PEM’ ($5.60) is payable with the G593 ‘COVDID-19 vaccine’ if the vaccine is the sole purpose for your patient’s visit.
In all primary care patient enrolment models, the G593 and Q593 will be out of basket.
You’re eligible to claim the new W593 for both enrolled and non-enrolled patients if you work in the following patient enrolment models:
- Family Health Organizations
- Family Health Networks
- Group Health Centre
- Rural and Northern Physician Group Agreements
- Weeneebayko Area Health Authority
- Saint Joseph’s Health Centre
- Toronto Palliative Care Agreements
- General Practitioner Palliative Care
- General Practitioner Focus Care of the Elderly
- General Practitioner Focus HIV
- Homeless Shelter Agreements
- Sioux Lookout Agreements
- Community Sponsored Agreement/Blended Salary Model
- New Graduate Entry Program
- Income Stabilization
- Aboriginal Family Health Team
- Family Health Team Specialists Physicians
You’re not eligible to claim the new G593 or the W593 sole visit premium if you’re working in Assessment Centres and in a Ministry designated COVID-19 Assessment Centre at the same time.
If you’re a Family Health Group (FHG) or Comprehensive Care Model (CCM) physician, you’ll claim the G700 ‘Basic fee-per-visit premium’ with G593 ‘COVID-19 vaccine’ (sole reason for visit).
The G593 ‘COVID-19 vaccine’ is not eligible for the FHG Comprehensive Care Premium (10%).
COVID-19 Vaccine Patient Facilitation Fee (Q007)
Effective March 6th, 2021, a new COVID-19 vaccine patient facilitation payment is payable at a one-time $6 fee per patient. This applies when a Public Health Unit or the province requests that you contact patients to help register or book their COVID-19 vaccination, or help complete patient consent or other documentation.
For each patient you provide this service to you’ll submit tracking code Q007. If you’re eligible for payment, the Ministry will pay a one-time lump sum for all submitted claims.
The terms and conditions regarding this payment are:
- Q007 isn’t payable if you only provide general information about accessing or registering for the vaccine
- Q007 isn’t payable in combination with G593 or H409/H410
- You can only bill Q007 once per patient while the Ministerial Order for G593 is in effect
You’ll receive a one-time lump sum payment for services provided on or after March 6th, 2021. Stay tuned for information on when payment will be made.
If you have any questions about these temporary fee codes, 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.
