Changes to Virtual Care on October 1, 2022 

Changes to Virtual Care on October 1, 2022 

What’s Changing?  

The temporary COVID virtual care codes (K080, K081, K082 and K083) that were introduced to help  manage the pandemic will expire on September 30, 2022. As of October 1, 2022, the permanent virtual  care framework negotiated as part of the 2021 Physician Services Agreement will come into force.  

Comprehensive Virtual Care  

Where a virtual care service is rendered to a patient with whom the physician has an established  physician-patient relationship, the service will pay: 

• 100% of the corresponding in person OHIP Schedule rate for services rendered by video; • 85% of the corresponding in person OHIP Schedule rate for services rendered by phone; and • 95% of the corresponding in person OHIP Schedule rate for K007 GP psychotherapy, K005  

primary mental health care, K197 individual outpatient psychotherapy, and K198 outpatient  psychiatric care when rendered by phone. 

For the purposes of the virtual care payment framework, an existing physician-patient relationship is  defined as: 

• Where a patient has had at least one insured service with a direct physical encounter with the  physician in the preceding 24 months; or 

• Where a patient is enrolled to a physician or another physician in the same group (and has  signed the Ministry’s Patient Enrolment and Consent to Release Personal Health Information  form); or 

• Where a specialist or GP focused practice physician provides an eligible insured consultation by  video; or 

• Where a physician provides any of the following services: 

Limited Virtual Care  

Where a physician renders a service to a patient where there is not an existing physician-patient relationship, the services are to be claimed using the new limited virtual care codes:

OMA Ontario Medical Association | Changes to Virtual Care on October 1, 2022 

• NEW Xxx1 Limited virtual care service – video $20.00 

• NEW Xxx2 Limited virtual care service – phone $15.00 

New Codes for GPs with a Focused Practice Designation  

Where a physician with a GP Focused Practice Designation renders a consultation by video, the following  new codes are applicable and pay at 100% of the corresponding in person GP consultation codes (A005,  A006, A905, A911 and A912): 

• NEW Zzz1 GP Focused practice designated consultation $84.45  • NEW Zzz2 GP Focused practice designated repeat consultation $45.90  • NEW Zzz3 GP Focused practice designated limited consultation $72.10  • NEW Zzz4 GP Focused practice designated special consultation $144.75  

• NEW Zzz5 GP Focused practice designated comprehensive consultation $217.15  

Premiums and Management Fees for GPs  

The following premium payments will be applied when the qualifying service is provided virtually: 

Outside Use  

All new family practitioner Virtual Care Services will be introduced as core services and in-basket for all  Primary Care Models. Existing core services selected as eligible for virtual care will remain in basket.  Virtual Care Services will contribute towards outside use and will be negated for all Primary Care Models  with an Access Bonus Payment, at an amount equal to the payment made for outside virtual care  services. 

1 Q040 is eligible when at least one K030 service is in person; virtual K030 is only eligible when an in person K030  has been rendered in the preceding 12 months

OMA Ontario Medical Association | Changes to Virtual Care on October 1, 2022 

Verified Virtual Visit Solution  

To be eligible for payment, physicians must use a verified virtual visit solution provider for video services  from one of the vendors listed here: https://www.ontariohealth.ca/verified-vendor-list. 

Source: PSA section B. Virtual Care; p. 29. 

For all PSA related FAQs please visit here. 

OMA Ontario Medical Association | Changes to Virtual Care on October 1, 2022