E060 – Post Renal Transplant Assessment Premium
OHIP Surgical Assists Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Post renal transplant assessment premium is payable in addition to the amount payable for an assessment. All of the following criteria apply: 1. The assessment is a: a. medical specific assessment (A163); b. medical specific re-assessment (A164); c. complex medical specific re-assessment (A161); or d. partial assessment (A168); 2. The service is rendered by a physician with a specialty designation in (16) Nephrology; 3. The assessment is not eligible for payment when rendered in an emergency department or emergency department equivalent or to a hospital inpatient; 4. The purpose of the assessment is post-transplant care; and 5. The patient is within the first three years of having received their renal transplant.
When to Use
- Use E060 when performing a routine follow-up assessment (A163 or A164) for a stable renal transplant patient within the 36-month post-operative window in your office.
- Apply E060 when billing a complex medical specific re-assessment (A161) for a patient within three years of transplant to account for the additional complexity of managing immunosuppression and graft function.
Common Pitfalls
- Billing E060 for patients beyond the 36-month post-transplant threshold will result in automatic rejection.
- Submitting E060 for assessments performed in a hospital outpatient clinic or emergency department is a common audit trigger and will be rejected as these settings are explicitly excluded.
- Attempting to claim E060 alongside hospital-based consultation codes is prohibited, as the premium is strictly limited to office-based assessments.
Billing Tips
- Ensure your billing software is configured to link E060 to the base assessment code (A161, A163, A164, or A168) to ensure the premium is triggered correctly on the same claim.
- Maintain a clear record of the transplant date in the patient chart to justify the three-year eligibility window during potential Ministry audits.
Percentage Premium: 0.25%
This code applies a percentage increase to the base procedure fee
Effective: April 1, 2020
A. Consultations and Visits
CONSULTATIONS AND VISITS
PercentageIncrease
Other Premiums (including After Hours Procedure Premiums)
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