All codes
Q020A
Q020A – Serious mental illness premium
OHIP Critical Care Code — APPENDIX Q · Schedule of Benefits
The Serious Mental Illness Premium (Q020A) is a special payment ranging from $1,200 to $2,400 for mental health services. It is payable to physicians in the following eligible models: FHN, FHO, FHG, BSM, GHC, RNPGA, WAHA, SJHC, GP Focused HIV, and Sioux Lookout Agreement.
When to Use
- Use Q020A when managing a patient with a confirmed diagnosis of schizophrenia, bipolar disorder, or major depressive disorder to claim the annual premium for comprehensive care.
- Apply this code when you have provided a minimum of four mental health-related service encounters within the fiscal year for a patient meeting the specific diagnostic criteria.
Common Pitfalls
- Billing Q020A for patients who do not meet the strict diagnostic criteria for serious mental illness, which often leads to recovery of funds during Ministry audits.
- Attempting to claim both Q020A and Q021A for the same patient in the same fiscal year, as these codes are mutually exclusive based on the intensity and nature of the provided care.
Billing Tips
- Ensure the patient's diagnosis is clearly linked to the specific ICD-9 codes recognized by the Ministry for serious mental illness to avoid automatic rejection of the premium claim.
Provider Fee$0.00
Effective: October 1, 2003
Category
AQ. Appendix Q
Subcategory
APPENDIX Q
Service Type
Other
Code Classes
Other Premiums (including After Hours Procedure Premiums)
The fee is a range from $1,200 to $2,400.
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