Ontario Ministry of Health and Long-Term Care - Ontario Health Insurance - Schedule of Benefits for Physician Services

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Text Only Version

Schedule of Benefits for Physician Services
under the Health Insurance Act

effective February 1, 2008

This information requires knowledgeable interpretation and is intended primarily for members of the professional health care community.

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TABLE OF CONTENTS

Numeric Index

General Preamble
Introduction

A Consultations and Visits
Family Practice & Practice in General
Anaesthesia
Cardiology
Cardiovascular & Thoracic Surgery
Clinical Immunology
Community Medicine
Dermatology
Emergency Medicine
Gastroenterology
General Surgery
General Thoracic Surgery
Genetics
Geriatrics
Haematology
Internal & Occupational Medicine
Laboratory Medicine
Neurology
Neurosurgery
Nuclear Medicine
Obstetrics & Gynaecology
Ophthalmology
Orthopaedic Surgery
Otolaryngology
Paediatrics
Physical Medicine & Rehabilitation
Plastic Surgery
Psychiatry
Diagnostic Radiology
Radiation Oncology
Respiratory Disease
Rheumatology
Urology

B Nuclear Medicine - IN VIVO
Preamble Cardiovascular System
Endocrine System
Gastrointestinal System
Genitourinary System
Haematopoietic System
Musculoskeletal System
Nervous System and Respiratory System
Miscellaneous
Scintimammography
Clinical Procedures Associated with Diagnostic Nuclear Medicine Procedures

C Radiation Oncology
Preamble
Radiotherapy
Radium and Radioisotopes (sealed sources)
Raidioisotopes (non-sealed sources)

D Diagnostic Radiology
Preamble
Head and Neck
Spine and Pelvis
Upper Extremities
Lower Extremities
Skeletal Surveys
Abdomen
Chest
Gastrointestinal Tract
Obstetrics and Gynecology
Genitourinary Tract
Fluoroscopy - by Physician With or Without Spot Films
Special Examinations
Bone Mineral Density (BMD) Measurement
Computed Tomography (CT)
Miscellaneous Examinations

E Clinical Procedures Associated With Diagnostic Radiological Examinations
Preamble
Angiography
Miscellaneous Procedures

F Magnetic Resonance Imaging (MRI)
Preamble

G Diagnostic Ultrasound
Preamble
Head and Neck
Thorax,Abdomen and Retroperitoneum
Pelvis
Pregnancy
Vascular System
Vascular Laboratory Fees
Miscellaneous
Ultrasonic Guidance

H Pulmonary Function Studies
Preamble

J Diagnostic and Therapeutic Procedures
Preamble
Allergy
Anaesthesia
Cardiovascular
Electrocardiography(ECG)
Non-Invasive Cardiography
Echocardiography
Critical Care
Dermatology
Dialysis
Other Home and Self Care Services
Endocrinology and Metabolism
Gastroenterology
Gynaecology
Injections or Infusions
Laboratory Medicine
Nephrology
Nerve Blocks
Neurology
Ophthalmology
Otolaryngology
Physical Medicine
Psychiatry and Respiratory Disease
Urology
Sleep Studies

K Obstetrics
Preamble
PrenatalCare
Labour-Delivery
Obstetrical Anaesthesia
High Risk Pregnancies·
Maternal-Fetal Procedures

Surgical Preamble
Preamble

M Integumentary System Surgical Procedures
Skin and Subcutaneous Tissue
Operations on the Breast

N Musculoskeletal System Surgical Procedures
Preamble
General Fees
Hand and Wrist
Elbow and Forearm
Shoulder, Arm and Chest
Skull and Mandible
Spine
Pelvis and Hip
Femur
Knee
Fibula and Tibia
Foot and Ankle

P Respiratory Surgical Procedures
Nose
Accessory Nasal Sinuses
Larynx
Trachea and Bronchi
Chest Wall and Mediastinum
Lungs and Pleura

Q Cardiovascular Surgical Procedures
Preamble
Heart and Pericardium
Valves
Arteries
Veins

R Haematic and Lymphatic Surgical Procedures
Spleen and Marrow
Lymph Channels

S Digestive System Surgical Procedures
Oral Cavity and Pharynx
Salivary Glands and Ducts
Lips
Endoscopic Ultrasound
Oesophagus
Stomach
Intestines(Except Rectum)
Miscellaneous
Rectum
Liver
Biliary Tract
Pancreas
Abdomen, Peritoneum and Omentum

T Urogenital and Urinary Surgical Procedures
Preamble
Kidney and Perinephrium
Bladder
Urethra

U Male Genital Surgical Procedures
Penis
Testis
Epididymis and Tunica Vaginalis
Scrotum
Vas Deferens
Spermatic Cord
Seminal Vesicles
Prostate

V Female Genital Surgical Procedures
Preamble
Vulva and Introitus
Vagina
Cervix Uteri
Corpus Uteri
Fallopian Tube
Ovary

W Endocrine Surgical Procedures
Thyroid Gland
Parathyroid,Thymus and Adrenal Glands

X Neurological Surgical Procedures
Cranial
Peripheral Nerves

Y Ocular and Aural Surgical Procedures
Eyeball
Cornea
Sclera,Iris and Ciliary Body
Crystalline Lens
Vitreous
Extra Ocular Muscles
Orbit
Eyelids
Conjunctiva
Lacrimal Tract
External Ear
Middle Ear
Inner Ear

Z Spinal Surgical Procedures
Preamble
Anterior Spinal Decompression
Anterior Spinal Arthrodesis following Decompression
Anterior Spinal Arthrodesis with Instrumentation without Decompression
Posterior Spinal Decompression
Posterior Spinal Arthrodesis following Decompression or Osteotomy
Posterior Spinal Arthrodesis as sole procedure Fractures of the Spine
Tumours/infections of the Spine
Deformities of the Spine
Revision Procedures for Spinal Surgery
Procedures on Musculoskeletal Elements
Procedures Involving Neural Elements
Meningocoele and Myelomeningocoele

Appendix A

Appendix B

Appendix C

Appendix D
Surface Pathology
Sub-Surface Pathology

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The content of this website is provided for information only. No assurance is given that the content is current or accurate. Users are cautioned against relying upon it without making reference to the regulation in effect defining the Schedule of Benefits as it is published from time to time pursuant to Ontario Regulation 552 under the Health Insurance Act.

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