Q116A – Cumulative Preventive Care Management Service Enhancement Code (Preventive Care Bonus) Childhood Immunizations - 90%
OHIP Critical Care Code — APPENDIX Q · Schedule of Benefits
The Cumulative Preventive Care Management Service Enhancement Code Q116A is a preventive care bonus paid to eligible physicians for achieving a 90% childhood immunization rate. The bonus amount is $1100. This code is billable by physicians in specific models (FHN, FHO, RNPGA, BSM, GHC, SJHC, SEAMO, WHA, CCM, and FHG) who meet the minimum roster size. The claim for this bonus must be submitted with a fee of $0.00.
When to Use
- Use Q116A when your rostered patient panel achieves the 90% immunization threshold for the childhood series as defined in the Appendix Q guidelines.
- Submit this code once the Ministry confirms your practice has met the specific immunization targets for the designated age cohort within your eligible FHO, FHN, or FHG model.
Common Pitfalls
- Billing Q116A without verifying that your rostered patients have completed the full immunization series, as incomplete records will lead to rejection during the Ministry's automated audit.
- Attempting to bill this code if you are not in an eligible model, such as a solo fee-for-service practice, which will result in an immediate rejection.
Billing Tips
- Ensure your EMR immunization tracking is synchronized with the Ministry's data to avoid discrepancies between your internal reporting and the Ministry's calculated 90% threshold.
- Always submit the claim with a $0.00 fee; any other amount will cause the system to reject the transaction instead of triggering the $1100 bonus payment.
Effective: March 1, 2005
AQ. Appendix Q
APPENDIX Q
ManagementFee
Other Premiums (including After Hours Procedure Premiums)
Physician must meet the minimum roster size for their eligible model.
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