Implementing UDT requires addressing numerous facets, and sustainability of the program and compensation for physician time are important for any program’s success. This section covers the billing of UDT…
There is a wide range of variability when billing urine drug testing that depends on numerous factors. This section is written for family physicians in the province of Ontario, however note that there are numerous different payment models and so there is no single approach. Also note that we are in an uncommon payment model called a Rural Northern Physician Group Agreement (RNPGA) where our UDT is considered “in-the-basket” and we receive 5% shadow-billing for what we bill. This has naturally led to us not being experts in the practical application of billing UDT ourselves.
Nevertheless, we have done the homework and at least laid out a review of the OHIP Schedule of Benefits that summarizes the important billing codes for UDT. Highlighted are points 4-8 as they are the most relevant when billing UDT for CNCP. Note that some of the billing codes referenced below – K682 and K683 (OAT), and K623 and K624 (Form 1 and Form 3) – would not be applicable to your CNCP patients.
So practically what this means is that if you do an IA UDT in the office with at least 4 panels, then you would bill a G040 ($15). You must have assessed the patient in that month to be eligible. Maximum of 3 in a given month (for chronic pain patients, this upper limit is only relevant for those that are in your “structured” risk stream as no other patients would be doing even close to this frequency). If you also do anti-tampering with creatinine and/or pH/specific gravity/oxidants, etc. then you would bill a G039 as well.
- Billing for many clinics is an important component of program sustainability.
- Spend the time in early stages inquiring into billing for your unique setting.
- Ministry of Health and Long Term Care. Schedule of Benefits: Physician Services Under the Health Insurance Act. November 2018. http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physserv/sob_master20181115.pdf. Accessed June 24, 2019.