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Q021A
Q021A – Serious mental illness premium
OHIP Critical Care Code — APPENDIX Q · Schedule of Benefits
Q021A is a special payment premium for mental health services provided to patients with serious mental illness. The payment for this service ranges from $1,200 to $2,400. This premium is only payable to physicians in specific eligible models as detailed on page .
When to Use
- Use Q021A when billing for the management of patients with a confirmed diagnosis of schizophrenia, bipolar disorder, or major depressive disorder as defined in the Appendix Q criteria.
- Apply this premium when the physician is enrolled in a specific primary care model that qualifies for the mental health incentive payment as outlined in the Schedule of Benefits.
Common Pitfalls
- Billing Q021A for patients who do not meet the strict diagnostic criteria for 'serious mental illness' will lead to automatic recovery during Ministry audits.
- Submitting both Q021A and Q020A for the same patient in the same fiscal period is a common error that will result in a rejection or clawback.
Billing Tips
- Ensure the patient's diagnosis is clearly documented in the EMR as a chronic condition to justify the premium, as this code is subject to high-frequency post-payment verification.
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