Regulation - LGIC

Amendments to Regulation 552 under the Health Insurance Act, Evidence Based Changes to the Schedule of Benefits for Physician Services

Regulation Number(s):
Instrument Type:
Regulation - LGIC
Bill or Act:
Health Insurance Act
Summary of Decision:
The proposed amendments were approved by Cabinet on May 30, 2011, and implemented on June 1, 2011, as planned.

A new Schedule of Benefits for Physician Services (containing the changes relating to OHIP payment for physician services) was made available on-line for physicians. An INFOBulletin was posted online advising physicians of the changes that became effective June 1, 2011.
Further Information:
Proposal Number:
Posting Date:
May 11, 2011
Summary of Proposal:
The Ontario Health Insurance Plan (OHIP) covers payments for medically necessary physician services, prescribed hospital and health facility services, certain dental surgical services that are required to be performed in a hospital, certain practitioner services that are therapeutically necessary. The Schedule of Benefits for Physician Services lists the physician services that are insured under Ontario's Health Insurance Act (HIA).

The proposed amendments will focus on evidence based recommendations and quality services related to the payment of fee-for-service physician services by OHIP. The proposed effective date of these changes is June 1, 2011.

To support better patient outcomes the ministry is proposing to:

- limit payment for urine and blood testing and vitamin injections in weight loss clinics;
- remove payment for excision of plantar warts (removal by other methods e.g., cryotherapy will remain insured).
To support the appropriate use of system resources the ministry is proposing to create a new fee code for preoperative assessment clinic examinations.

To support evolving technology the ministry is proposing to:
- clarify payment conditions for pulmonary function tests;
- reduce the fees payable for cardiac loop recording;
- introduce record keeping requirements and a technical fee code for hospitals for a new contrast agent for echocardiography;
- create a new fee code for portable ultrasounds in ER.
Contact Address:
370 Select Drive
Kingston ON K7M 8T4
Effective Date:
June 1, 2011