Great News! New Billing Code for ME/CFS & FMS in Ontario

Medical - Overviews

New Billing Code (K037 OHIP) for Fibromyalgia/Chronic Fatigue Syndrome for Ontario

THE MYALGIC ENCEPHALOMYELITIS ASSOCIATION OF ONTARIO is pleased to inform you that 'Fibromyalgia/Chronic Fatigue Syndrome care' has now the OHIP time-based billing Code number K037.

In the past, many physicians have refused to accept M.E./CFS/FM patients because "they took too long". However, with this new code, physicians will be paid for the time they spend with patients who have these complex illnesses.

OHIP has notified all of Ontario's Physicians of this new Code.

In addition, the new Diagnostic Code for CFS, number 795, picked up the newly diagnosed patient, but with the new K037 Code, patients who were previously diagnosed will be able to be recorded by OHIP thus allowing future statistics to be collected on these illnesses in the Province of Ontario.

(We do recognize that there are areas in Ontario where there is such a severe shortage of physicians that M.E./CFS and FM patients still may not be able to have all the time they need in one visit.)

Many thanks to all who have helped this come about:

  • Dr. Alison Bested for her excellent presentation to the Ontario Medical Association;
  • the National ME/FM Action Network for initiating the Canadian ME/CFS and Fibromyalgia Definition, Diagnostic and Treatment Protocols;
  • Board of Directors of The Myalgic Encephalomyelitis Association of Ontario for their meetings and advocacy with the Ontario Ministry of Health and our Members who have written, called their MPs and written to the Ministry of Health
  • the Ontario Support Group Leaders and their Members
  • individuals throughout the province who have advocated on behalf of CFS

If I may borrow a phrase: " it takes a village"

Thanks everyone for all your hard work and efforts in having CFS and FM accepted and recognized for the complex illnesses that they are by the Ontario Medical Association!!

Audrey Mac Kenzie, RN

The Myalgic Encephalomyelitis Association of Ontario

The National ME/FM Action Network would like to give a special thanks to Audrey Mac Kenzie for all the wonderful work she has done for the ME/CFS community!

Let’s use this example to get similar billing codes in other provinces!