The 2023 – 2027 Physician Services Agreement includes changes to the visit pages for General Practice, Pediatrics and Obstetrics and Gynecology, effective October 1, 2023. These changes simplify how physicians will claim for visits, especially when there are ​“add-ons” such as pelvic examinations, pap tests and age premiums.

The simplified visit page will reduce the number of tariffs located on the General Practice Visit Page and provide a more intuitive claims experience for physicians. Equally important is that the simplified visit page will deliver improved value for patient visits that include multiple components. 

Here’s an example for family physicians of how the new approach for pelvic examinations and pap tests will more appropriately compensate physicians for the added time and care with each patient:

For family physicians and general practitioners, the new simplified tariff structure is as easy as 1 – 2 – 3. This approach will reduce 19 different visit tariffs into an easier to navigate structure. Enhancements for in-person exams that include a pelvic exam and pap test that will result in an average of $27 more per visit. 

Note: We have made a cheat sheet to help your clinic translate the 19 old tariffs into the new simplified structure. Download and print a copy here.

Step 1 — Select Appropriate Visit Type

Step 2 — Apply Age Premium (if applicable)

UPDATE: For visits on or after February 15, 2024, the age premium will be automatically applied. Visits prior to February 15, 2024, will require the appropriate age premium add on tariffs as listed below. If you claim the age premium add on tariff for visits on or after February 15, 2024, you will see rejection code 6G — age premium applied.

Step 3 — Add Additional Components (if applicable)

Pediatrics Simplified Visits

Below are all the tariffs you will need to use to claim for your common visits, as a Pediatrician. Please note that pediatricians also have access to tariff 8415 which replaces the previous extended visit tariffs.

Step 1 — Select Appropriate Visit Type

Step 2 — Add Visit Extender (if applicable)

Step 3 — Add Additional Components (if applicable)

Obstetrics and Gynecology Simplified Visits

Below are all the tariffs you will need to use to claim for your services, as an obstetrician gynecologist. Please note that you also have access to claiming tariff 8415 which provides for extended visit tariffs

Step 1 — Select Appropriate Visit Type

Step 2 — Add Visit Extender (if applicable)

Step 3 — Add Additional Components (if applicable)

Rule of Application Modernized

An additional change has been made that clarifies a physician’s ability to claim for the pelvic examination tariff. Rule of Application 17 has been comprehensively redrafted through a gender equity lens. It now defines what constitutes a pelvic examination, differentiated by whether the patient is pregnant. This language has been crafted to more closely represent the true nature of patient presentations where not all components are always needed. Physicians are enabled to provide the most appropriate care to their patients without penalization.

17 — PELVIC EXAMINATIONS 

17(a) A Pelvic Examination provided to a patient who is not pregnant is usually comprised of the following elements, where indicated: 

• Performance of visual inspection of the vulva and perineum;
• Insertion of speculum into the vagina to inspect the vault and cervix;
• Bimanual examination of the uterus and ovaries, and
• Conduction of pelvic-rectal examination.

17(b) A comprehensive pelvic examination provided to a pregnant patient who is presenting with a concern that may be unrelated to the pregnancy, is usually comprised of the following elements, where indicated:

• Performance of visual inspection of the vulva and perineum;
• Insertion of speculum into the vagina to inspect the vault and cervix;
• Bimanual examination of the uterus;
• Conduction of pelvic-rectal examination.