Q & A for MRI services fee review

The WSIB recently completed a review of fees for Magnetic Resonance Imaging (MRI) services. A new fee schedule for MRI services will be in effect for services provided on or after October 1, 2009.

If you have any questions about the MRI fee schedule, please call the WSIB’s Health Care Practitioner Access Line at 416-344-4526 or toll-free at 1-800-569-7919.

1. Why has the WSIB fee for MRI services decreased? What is the new fee for MRI services and what is included in the fee?

The WSIB has become more proactive in its approach to purchasing health care services – with a focus on quality care, access, costs, and measurable outcomes. The purpose of the review of MRI fees was to develop the new fee schedule for MRI services (185k, pdf). Fees for MRI services were originally set in 1992 in accordance with the inter-provincial rate and when the technology was new and not as available. Today MRI services are less expensive and the WSIB is setting its fees to be more consistent with current pricing for MRI services in Ontario.

The new per diem fee is $875.00 for MRI services. This fee includes completion and submission of the report to the WSIB.

2. How did the WSIB determine the new fee?

A market-based approach was used to determine the current market conditions in Ontario, based on a study of fees currently paid by the WSIB.

3. Why has the MRI fee been removed from the hospital out-patient fee schedule?

The WSIB removed the MRI fees from the hospital out-patient fee schedule noting that private facilities can also bill for this service. The WSIB plans to review other fees and services in the hospital out-patient fee schedule separately.

4. If the referral is for more than one MRI scan, can the MRI facility request to book them on separate days?

Pre-approval with medical rationale is required when seeking to book scans on more than one day. The request must be submitted in writing with a significant reason for this request. The WSIB fee of $875.00 for MRI services is a per diem (daily) rate per injured worker (single or multiple scans).

5. Will accessibility to MRI services be compromised?

No. By continuing to provide MRI services through hospitals and independent MOH&LTC approved health facilities across the province the WSIB can ensure accessibility to injured workers within their communities.

6. Will workers have access to timely MRI services?

No delays in arranging MRI services are expected due to this fee change. Injured and ill workers are referred directly to MRI services by a qualified health practitioner without WSIB staff involvement. In some cases, WSIB staff can assist workers and their treating health practitioners to find MRI services that can be provided in a timely manner.