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Q152A
Q152A – Colorectal cancer screening test completion fee
OHIP Critical Care Code — APPENDIX Q · Schedule of Benefits
The Q152A is a Colorectal Cancer Screening Test Completion Fee. It is payable once per patient every two years. An exception applies if a patient has a negative colonoscopy (defined as revealing either no polyps or only hyperplastic polyps in the sigmoid or rectum); in this case, the fee is only payable after a period of 10 years, unless earlier screening is clinically indicated based on the findings, advice, and/or recommendations of the specialist who performed the colonoscopy. For minimum requirements to claim this fee, refer to INFOBulletin 4723.
When to Use
- Use Q152A when you have successfully facilitated the completion of a FIT test or colonoscopy for an eligible patient who is not rostered in a Patient Enrolment Model.
- Claim this code when you have reviewed the screening results with the patient and updated their medical record to reflect the completed screening cycle.
Common Pitfalls
- Billing Q152A for patients enrolled in a FHO, FHN, or other Patient Enrolment Model is a common rejection, as these physicians are compensated through the Preventive Care Bonus.
- Submitting Q152A more frequently than the two-year interval without a documented clinical exception will trigger an automatic rejection or potential audit recovery.
- Failing to confirm the patient's screening history can lead to errors; if a patient had a negative colonoscopy, the 10-year rule overrides the standard two-year eligibility.
Billing Tips
- Verify the patient's enrolment status in the Ministry database before billing to ensure they are not part of a model that includes Preventive Care Bonuses.
- Maintain a clear record of the screening completion date to easily calculate the next eligible date for Q152A and avoid premature billing.
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