Effective April 1, 2025, the following new telehealth fee item has been added under

the heading “Telehealth Service with Direct Interactive Video Link with the Patient”

in the Section of Rheumatology of the MSC Payment Schedule:

P31150 Telehealth extended consultation - exceeding 53 minutes

(actual physician time spent with patient). To consist of

examination, review of history, laboratory, X-ray findings,

necessary to initiate care ……………………………………... $349.17

Notes:

i) Restricted to Rheumatology.

ii) Applicable to patients with chronic and complex medical

needs. Paid with the following diagnostic codes:

a. Diffuse Diseases of Connective Tissue (710),

Systemic Lupus Erythematosus (710.0),

Systemic Sclerosis (710.1), Sicca Syndrome

(710.2), Dermatomyositis (710.3),

Polymyositis (710.4), Other (710.8),

Unspecified (710.9);

b. Rheumatoid Arthritis and other Inflammatory

Polyarthropathies (714), Rheumatoid Arthritis

(714.0), Felty’s Syndrome (714.1), Other

Rheumatoid Arthritis with Visceral or

Systemic Involvement (714.2), Juvenile

Chronic Polyarthritis (714.3), Chronic

Postrheumatic Arthropathy (714.4), Other

(714.8), Unspecified (714.9);

c. Polyarteritis Nodosa and Allied Conditions

(446), Polyarteritis Nodosa (446.0), Acute

Febrile Mucocutaneous Lymphnode

Syndrome (MCLS) (446.1), Hypersensitivity

Angiitis (446.2), Lethal Midline Granuloma

(446.3), Wegener’s Granulomatosis (446.4),

Giant Cell Arteritis (446.5), Thrombotic

Microangiopathy (446.6), Takayasu Disease

(446.7);

d. Ankylosing Spondylitis and Other

Inflammatory Spondylopathies (720),

Ankylosing Spondylitis (720.0), Spinal

Enthesopathy (720.1), Sacroiliitis, not

Elsewhere Classified (720.2), Other

Inflammatory Spondylopathies (720.8),

Unspecified Inflammatory Spondylopathy

(720.9);

e. Psoriasis and Similar Disorders (696),

Psoriatic Arthropathy (696.0), Other Psoriasis

(696.1), Parapsoriasis (696.2), Pityriasis rosea

(696.3), Pityriasis Rubra Pilaris (696.4), Other

Unspecified Pityriasis (696.5), Other (696.8).

f. Arthropathy associated with infections (711);

g. Polymalgia rheumatic (725);

iii) Paid to a maximum of one per patient within six months of

the last visit.

iv) Not paid when there is no change in condition from

previous assessment.

v) Start and end times must be recorded on claim and in the

patient’s chart.

Effective April 1, 2025, new fee item 01883 Trauma-informed comprehensive

gynecologic assessment in an Emergency Department (extra) is added to the

MSC Payment Schedule in the Section of Emergency Medicine.

P01883 Trauma-informed comprehensive gynecologic assessment

in an Emergency Department (extra) 40.00

Notes:

i) Payable only to emergency physicians.

ii) Payable only in addition to 01810, a level I emergency

care fee (01811, 01821, 01831, 01841), a level II

emergency care fee (01812, 01822, 01832, 01842),

a level III emergency care fee (01813, 01823, 01833,

01843), an out-of-office visit (12200, 13200, 15200,

16200, 17200, 18220), or an out-of-office consultation

(12210, 13210, 15210, 16210, 17210, 18210).

iii) Must include a speculum exam documented in the

patient’s chart.

iv) Not payable with a procedural fee that includes a

speculum exam, such as 14541.

Effective April 1, 2025, new fee item 13121 (Family Conference - per 15 minutes

or greater portion thereof) is added to the MSC Payment Schedule:

P13121 Family Conference - per 15 minutes or greater

portion thereof $50.35

Notes:

i) Restricted to family physicians.

ii) Payable for in-person or telehealth participation in a family

conference with one or more family members,

representatives, or substitute decision makers.

iii) Payable only for family conferences for the purpose of:

a) Obtaining informed consent for care related to an acute

medical event or a significant change in the patient’s

condition; or

b) Developing and reviewing the patient’s care plan,

including advanced care planning and goals of care

discussions.

iv) Not payable when communication occurs as a part of

routine communication with a family member,

representative, or substitute decision maker.

v) Payable in addition to a patient visit or 14067/14077 on the

same day if clinically required, provided that this service

does not take place concurrently with the family

conference (i.e., the visit time must be separate from the

family conference time).

vi) Payable to a maximum of 2 units per patient per physician

per calendar day.

vii) Payable to a maximum of 100 units per physician per

calendar year.

viii) Details of the family conference must be documented in

the patient’s chart, including the participants, their roles,

information about the discussion, and decisions made.

ix) Start and end times must be entered in both the billing

claim and the patient’s chart.

Effective April 1, 2025, the following new telehealth fee item has been added under

the heading “Referred Cases” in the Section of Neurology in the MSC Payment

Schedule:

P00452 Neurology in-hospital consultation - extra...................................... $25.00

Notes:

i) Not for patients seen within the last 6 months by the same physician

for the same or related condition.

ii) Payable in addition to 00410, 00441, and 40441.

iii) Not payable for hospital outpatients, or for patients located in

transient ischemic attack (TIA) or rapid access neurology clinics.

iv) Daily maximum of 5 claims per day per Neurologist.

Effective April 1, 2025, Family Practice Services Committee (FPSC) fee item

14086 FP Assigned Inpatient Care Network Initiative will be deleted from the

MSC Payment Schedule. The last quarterly service date of billing is January

1, 2025. This payment covers networking activities from January 1 to

March 31, 2025.

Beginning April 2025, eligible physicians participating in the Assigned

Inpatient Network will claim the payment by submitting a FPSC payment

claim form. More details on how to claim the network payment will be shared

by FPSC as soon as possible.

Additionally, FPSC fee item 14088 (FP Unassigned Inpatient Care Fee) is

amended to remove the submission requirement of the network registration

forms for the Unassigned Inpatient Care Network and Maternity Care

Network due to the deletion of 14086 and 14010 Maternity Care Network

Initiative Payment. Instead, eligible family physicians must be acti vely

participating in an FP Assigned Inpatient Network, an FP Unassigned

Inpatient Care Network and/or an FP Maternity Network.

Effective April 1, 2025, Family Practice Services Committee (FPSC) fee item

14010 Maternity Care Network Initiative Payment will be deleted from the

MSC Payment Schedule. The last quarterly service date of billing is

March 31, 2025. This payment covers networking activities from January 1

to March 31, 2025.

Beginning April 2025, eligible physicians participating in the Maternity Care

Network will claim the payment by submitting a FPSC payment claim form.

More details on how to claim the network payment will be shared by FPSC

as soon as possible.

Effective April 1, 2025, the Extended consultation-exceeding 53 minutes, fee item

31050, and the Multidisciplinary Care Assessment for community-based patients,

fee item 31060 in the MSC Payment Schedule have clarified that these can be

performed via telephone and video conferencing technology as well as in-person.

Additionally, note iv) under FI 31050 has been removed.

Effective April 1, 2025, the following fee item is amended. Fee item 07431 is not

intended for the repair of a diaphragmatic hernia and excludes procedures repairing

a minor iatrogenic laceration of the diaphragm:

V07431 Full thickness repair diaphragmatic injury (traumatic) with

or without mesh

Effective April 1, 2025, the following fee items are placed under a new heading and

amended. For anti-reflux procedures, such as fundoplications, etc., please use fees

listed in the “Oesophagus” section of the General Surgery fee guide:

Repair of diaphragmatic hernia of any type, with or

without fundoplication, vagotomy, or drainage procedure:

CV70603 - laparoscopic

CV70604 - congenital diaphragmatic hernia

CV70605 - open

V70607 Imbrication of diaphragm for eventration, transthoracic or

transabdominal

Note: For anti-reflux procedures, such as fundoplications,

etc., please see Oesophageal section.

Effective April 1, 2025, fee items 70602 (diaphragmatic or other hernia – open) and

70606 (repair diaphragmatic hernia or laceration -chronic) are deleted from the MSC

Payment Schedule.

Effective March 8, 2025, note i) and note ii) for all Family Medicine individual

counselling fees are amended as follows:

Counselling - Individual

For a prolonged visit for counselling (minimum time per visit –

20 minutes)

Notes:

i) MSP will pay for up to four (4) individual counselling

visits (any combination of age-appropriate in-office,

out-of-office, and telehealth) per patient per year (see

Preamble D. 3. 3.)

ii) Start and end times must be entered in both the billing

claim and the patient’s chart.

iii) Documentation of the effect(s) of the condition on the

patient and what advice or service was provided is

required.

Effective April 1, 2025, note ii) of the fee item 32271 is amended from “one per

patient in a 6 month period” to “for hospital in-patients, paid once per patient per

hospital admission”:

Effective August 1, 2024, fee item 04250 (Hysteroscopic removal of endometrial polyp(s), retained placental or other intrauterine tissue(s), and/or fragmented

intrauterine device) has been added to the list of fees eligible with the modifiers

04719 (gynecology surgical surcharge for patients 75 years and older) and 04720

(Body Mass Index surgical surcharge). The amended descriptions for fee items

04719 and 04720 are now the following:

G04719 Gynecology surgical surcharge for patients 75 years and older

Notes:

i) Restricted to Obstetrics and Gynecology specialists.

ii) Fee item G04719 will only be paid once whether single or

multiple procedures are performed under the same anesthetic.

iii) Paid with the following surgical procedures: 04701, G04702,

G04703, G04704, G04705, G04706, 04707, 04709, 00704,

00705, 00770, 00807, 00808, 00878, 04001, 04003, 04011,

04029, 04032, 04033, 04041, 04042, 04048, 04202, 04203,

04212, 04217, 04218, 04219, 04220, 04223, 04227, 04228,

04229, 04232, 04233, 04250, 04301, 04303, 04306, 04307,

04309, 04311, 04312, 04316, 04318, 04320, 04322, 04401,

04402, 04405, 04406, 04408, 04410, 04411, 04421, 04422,

04424, 04427, 04429, 04500, 04508, 04510, 04512, 04530,

04531, 04551, 04605, 04621, 04622, 04623, 04624, 04628,

04662, 04728, 04729, 07027, 07597, 07634, 08178, 08205,

08232, 08250, 08255, 08257, 08263, 08278, 08282, 08283 or

70120.

iv) Applies to procedures performed in hospital operating room,

ambulatory care or office setting.

P04720 Body Mass Index Surgical Surcharge payable at 25% of listed fee for

surgery or procedure performed for patients with a BMI of 35

or greater.

Notes:

i) Payable only to Obstetricians and Gynecologists.

ii) Patient’s BMI must be provided in the claim note record and

documented in the patient’s chart and/or operative report.

iii) Maximum of one surcharge per operation unless two

obstetricians or gynecologists perform two synchronous

surgeries that are both eligible forthe surcharge.

iv) When multiple procedures are performed during the same

operation, the surcharge applies to all eligible procedures based

on the prorated value according to the applicable preamble(s).

v) The surcharge does not apply to surgical fee modifiers 04715,

04716 or 04719, but may be paid in addition.

vi) Not payable if 04708 or 04714 is billed with the surgery or

procedure.

vii) Out-of-Office Hours operative surcharges (01210, 01211 and

01212) are not to be paid on the BMI surcharge.

viii) The surcharge is excluded from the calculation of total operative

fee(s) for which surgical assist fees are based.

ix) Payable when the following Obstetrics and Gynecology fee

items are performed for patients with a BMI of 35 or greater:

00770, 00775, 00776, 00787, 00794, 00807, 00808, 00815,

00819, 04000, 04001, 04003, 04011, 04014, 04017, 04018,

04022, 04023, 04024, 04025, 04026, 04029, 04032, 04033,

04034, 04035, 04036, 04037, 04040, 04041, 04042, 04043,

04044, 04045, 04047, 04048, 04049, 04050, 04052, 04080,

04085, 04106, 04110, 04111, 04114, 04116, 04141, 04142,

04201, 04202, 04203, 04204, 04206, 04208, 04212, 04216,

04217, 04218, 04219, 04220, 04221, 04222, 04223, 04224,

04225, 04227, 04228, 04229, 04230, 04232, 04233, 04250,

04300, 04301, 04303, 04304, 04305, 04306, 04307, 04309,

04311, 04312, 04316, 04318, 04320, 04322, 04401, 04405,

04406, 04408, 04410, 04411, 04421, 04422, 04424, 04427,

04429, 04500, 04502, 04503, 04508, 04510, 04512, 04515,

04516, 04517, 04530, 04531, 04536, 04551, 04602, 04605,

04616, 04617, 04620, 04621, 04622, 04623, 04624, 04628,

04630, 04631, 04632, 04633, 04640, 04641, 04660, 04662,

04664, 04680, 04701, 04702, 04703, 04704, 04705, 04706,

04707, 04709, 04728, 04729.

As the effective date for these amendments is retroactive, pre-approval has been

granted for claims past 90 days from the date of service. Please submit any claims

for surcharges that are now eligible using Submission Code “A” in order to avoid

refusals due to the claims being past the submission cut-off.

These over-age claims must be submitted using the instructions above within 60 days of this remittance payment date or they will be refused with Explanatory Code “BV.”

For more information on recent Broadcast messages from MSP, you can contact MSP directly or reach out to our Billing Team for further support.
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Happy Billing!