New Fee Items/Tariffs
The fee schedule is modernized and updated by the SMA Tariff Committee. This includes establishing new fees, as well as making changes to assessment rules, fee code descriptions, or any other facet of the fee schedule, and clarifying billing protocols.
The Tariff Committee works closely with Ministry of Health representatives who also attend its meetings. Any fee schedule changes are subject to final approval by the SMA/Government Payment Schedule Review Committee.
Requesting New Fees or Payment Schedule Changes
Physicians are encouraged (though not required) to first discuss their ideas with their specialty section representative, and to complete and submit a New Fee Item Request Form (doc, PDF) to the Tariff Committee. Those requesting technical fees should also complete a Technical Fee Worksheet to assist in the calculation of equipment, facility, and staff costs for the procedure.
Several considerations guide the Committee’s review:
- Does the section support the proposal?
- Is the procedure supported by medical evidence?
- Does the new procedure substitute for existing fees (this can be especially relevant from a costing perspective)?
- Has the fee been implemented in other jurisdictions (provinces)? If so, how does the recommended fee compare with what is paid elsewhere?
- How does the fee compare with work of similar complexity, time, and effort?
- What is the estimated annual volume of services?
After considering these factors, the Tariff Committee will make a recommendation to either adopt the fee, adopt the fee with changes, or reject the proposal.
If accepted, the Committee will send the proposal forward to the Payment Schedule Review Committee (PSRC). The PSRC is the forum where the SMA and Government provide formal input and make a final decision on whether or not to add a new fee or change an existing fee. There are often more items than there is budget available to pay for them. Some items may be carried forward for consideration in subsequent years, or be passed to the appropriate section for inclusion in their next fee schedule allocations.