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K887 – CTO initiation

OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits

CTO initiation is a time-based service that includes completing the CTO form and all preceding CTO services directly related to the initiation. A single all-inclusive claim for CTO initiation is submitted once per patient per physician per initiation in any six-month period and is assessed on an Independent Consideration basis. Claims must be submitted with the MOH form for elapsed times. For definitions and general time-keeping requirements, refer to , to .
The form provided by the MOH for elapsed times must be completed and submitted with each claim and a copy retained on the patient's permanent medical record.
The total number of allowable units must be calculated by adding the actual elapsed time of each insured activity rounded to the nearest minute, divided by 30 and rounded to the nearest whole unit.
The physician must record on the patient's permanent medical record or chart the time when the insured service started and ended, as required for all unit-based services.

A single all-inclusive claim for CTO Initiation or CTO Renewal is submitted once per patient per physician per initiation or renewal in any six month period on an Independent Consideration basis.

A single all-inclusive claim for CTO Supervision is submitted once per patient per month on an Independent Consideration basis.

The form provided by the MOH for elapsed times must be completed and submitted with each claim and a copy retained on the patient's permanent medical record.

The total number of allowable units rendered per claim shall be determined by adding the actual elapsed time of each insured activity rounded to the nearest minute, dividing by 30 and rounding to the nearest whole unit.

Travel to visit an insured person within the usual geographic area of the physician's practice is a common element of insured services. Time units for any CTO services based in whole or in part on travel time are therefore insured but payable at nil.

Travel time and expenses related to appearances before the Consent and Capacity Board are not insured.

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