Each year, the Ontario Ministry of Health updates the Schedule of Benefits (SOB), impacting how physicians bill OHIP. Here’s what you need to know about changes coming in 2025:
1. New Telehealth Billing Codes
As virtual care continues to evolve, OHIP has added new fee codes for virtual consultations. These are specific to patient type (e.g., K083 vs. K084) and time spent.
2. Changes to Minor Assessment Codes
Several minor assessment codes have been consolidated or adjusted in value. Ensure your EMR or billing software reflects these updates to avoid underbilling.
3. Enhanced Premium Tracking
New requirements mandate more detailed reporting when claiming premiums for after-hours or complex patient cases.
4. Reimbursement Adjustments
Some procedure fees have been slightly reduced to reflect new cost structures. Always check the updated SOB for correct fee values.
Stay informed by subscribing to the Ministry’s bulletin or using a billing partner who stays up to date. Ignoring changes can lead to rejected claims or lost revenue.
