E431 – Cervical cancer screening specimen collection premium
OHIP Surgical Assists Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
This code is an add-on premium, payable in addition to G394 or certain assessments, when cervical cancer screening specimen(s) are collected in a setting other than a hospital or an Integrated Community Health Services Centre (ICHSC). Its eligibility is dependent on meeting the specific criteria for G394.
When to Use
- Use E431 as an add-on to a consultation or assessment (e.g., A007) when you perform a cervical cancer screening specimen collection during that visit, as G394 itself is restricted with these services.
- Use E431 when performing a cervical cancer screening specimen collection during a visit where you are also billing for a colposcopy service, as G394 is ineligible in this scenario.
Common Pitfalls
- Billing E431 in the same month as the monthly management fee W010 will result in a rejection, as E431 is considered a component of the W010 fee.
- Attempting to bill E431 for a collection performed within a hospital or an Integrated Community Health Services Centre (ICHSC) will lead to a rejection, as this premium is strictly for community-based settings.
Billing Tips
- Always ensure the clinical indication for the specimen collection meets the specific criteria for G394 (e.g., post-hysterectomy vault testing or immunocompromised status) to validate the E431 premium claim.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Premium
Diagnostic and Therapeutic Procedures, Other Premiums (including After Hours Procedure Premiums)
Female
G394 is not eligible for payment when performed in conjunction with a consultation, repeat consultation, general or specific assessment or reassessment or routine post-natal visit when a pelvic examination is a normal part of the foregoing services. One of the add-on codes E430 or E431 is eligible for payment in addition to these services when an insured collection of cervical cancer screening specimen(s) is performed outside of hospital or ICHSC.
G394 is not eligible for payment when performed in conjunction with an insured colposcopy service. One of the add-on codes E430 or E431 is eligible for payment in addition to these services when an insured collection of cervical cancer screening specimen(s) is performed outside of hospital or ICHSC.
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