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Q115A
Q115A – Cumulative Preventive Care Management Service Enhancement Code (Preventive Care Bonus) Childhood Immunizations - 85%
OHIP Critical Care Code — APPENDIX Q · Schedule of Benefits
This is a Cumulative Preventive Care Management Service Enhancement Code, also known as a Preventive Care Bonus, for achieving an 85% immunization rate for childhood immunizations. This code is billed at $0.00 and results in a bonus payment of $440. It is only available to physicians in specific eligible models (FHN, FHO, RNPGA, BSM, GHC, SJHC, SEAMO, WHA, CCM and FHG) who meet the minimum roster size for their model.
When to Use
- Use Q115A when your rostered patient panel achieves the 85% immunization threshold for the childhood immunization target group as defined in the Preventive Care Bonus program.
- Submit this code once you have confirmed your roster meets the minimum size requirements for your specific funding model (FHO, FHN, FHG, etc.) and you have verified the immunization completion rates for your eligible patients.
Common Pitfalls
- Billing Q115A without meeting the minimum roster size requirement for your specific model will result in an automatic rejection or clawback during the Ministry's reconciliation process.
- Confusing Q115A with Q116A, which is the 95% threshold bonus; ensure your calculated percentage meets the specific 85% tier before submission.
Billing Tips
- Monitor your Preventive Care Bonus reports via the Ministry's portal regularly to track your progress toward the 85% target before submitting the claim.
- Ensure all childhood immunizations are correctly coded with the appropriate service codes (e.g., G538) throughout the year, as missing claims will artificially lower your immunization rate and disqualify you from the bonus.
Provider Fee$0.00
Effective: March 1, 2005
Category
AQ. Appendix Q
Subcategory
APPENDIX Q
Service Type
Other
Code Classes
Other Premiums (including After Hours Procedure Premiums)
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