It is mandatory to report Tuberculosis (TB) infection and disease to Public Health.
Patient consent is not required for reporting this information.


How do you process a bill for a Tuberculosis (TB) Mantoux Test?

If a Ministry of Health program, such as the Public Health Department requests a TB test and a completed form/report, then both the test and completion of the form/report cannot be billed to the patient. Only the appropriate OHIP fees can be claimed. (e.g., A001 for the visit/assessment and G372 for the injection).

When is a TB skin test eligible for Ontario Health Insurance Plan (OHIP)  coverage?

Medically necessary TB skin tests and documentation are covered under OHIP. These include testing for:

  • people who are identified contacts of a TB case
  • people who have recently immigrated from countries where TB is more common

TB skin tests and documentation are also covered under the OHIP for:

  • people who require evidence of a completed TB skin test for admission or continuation in a daycare or pre-school program or a school, community college, university or other educational institution or program (including a work placement that the program may require)
  • people who are 65 years of age or younger need to be admitted to a Long Term Care Facility

What if a TB test is requested solely for employment/volunteer purposes (e.g., a hospital)?

The test and the completion of the form are uninsured and can be billed to the patient or third party.

Can I use serum provided by the government for uninsured TB testing?

Please note that serum provided by the government is not to be used for uninsured TB testing. When uninsured testing is performed, the serum should be either:

  • acquired by the physician and sold to the patient at a direct cost (with reasonable mark-up to account for any indirect costs (e.g., storage, administrative, etc.), or
  • acquired by the patient from the pharmacy, via prescription provided by the physician

Where can I get more information on when it is appropriate to bill OHIP for TB testing?

The following information appears in the Ontario Medical Association (OMA) Physician’s Guide to Third Party and Other Uninsured Services, January 2011 edition, page 17, and is published with permission of the OMA.

Source: Section 24, Regulation 552 of the Health Insurance Act

The 7th edition of the Canadian Tuberculosis Standards was posted in pre-release June 20, 2013 on the Canadian Thoracic Society’s Canadian Respiratory Guidelines website and can be downloaded at no charge. The Standards are also available in an online supplement of the Canadian Respiratory Journal.

The Canadian TB Standards cover the diagnosis and treatment of Latent Tuberculosis Infection (LTBI) and active TB disease in adults and children, as well as chapters on infection control, specific high-risk patients and circumstances such as HIV and drug-resistant TB, and contact follow-up. The 7th edition has been extensively revised to incorporate new developments over the last 10 years in understanding the pathogenesis, immunology and epidemiology of TB, as well as new diagnostic and therapeutic tools.

Each chapter is written by experts from across Canada and is based upon the best available scientific evidence. The Standards are jointly funded, edited and produced by the Canadian Thoracic Society of the Canadian Lung Association and the Public Health Agency of Canada.

  • TB-UP is a program funded by the Ministry of Health and Long-Term Care and covers the cost of diagnostic tests and outpatient treatments for persons eligible for the program. Diagnostic tests include TB skin tests, chest x-rays, sputum, other labs, etc. Outpatient treatments include all medications for TB, physician visits, etc.
  • Persons who are not covered by OHIP, Interim Federal Health (IFH) or any other private health insurance plan can be assessed and/or treated for suspect or active TB.
  • Contacts of an active TB case with no healthcare insurance can also be assessed under this program.

Who is eligible for coverage under the TB-UP program?

  • Patient with a suspect or confirmed case of active TB (even if the final diagnosis is not TB, the work-up is still covered for patients who were considered to have suspect TB), or
  • Patient is a contact of a person with active TB, and
  • Patients who do not have other medical insurance/coverage for TB services such as:
    • OHIP coverage (person in the three month waiting period for OHIP would be eligible for coverage under the TB-UP program)
    • Interim Federal Health (available for refugee claimants)
    • medical insurance from another territory/province which covers the cost of TB services
    • any other medical insurance which covers the cost of TB services (e.g. private medical insurance)
  • Patient is a visitor, student, or resident currently in Ontario.

How do I register a patient for the TB-UP program?

  • Health care providers can register patients for the TB-UP program by contacting Toronto Public Health at 416-338-7600 prior to providing service.
  • Under exceptional circumstances, patients may be registered while in the physician’s office or hospital clinic
  • Patients must be registered with TB-UP prior to provision of service; retroactive payments for persons who receive TB diagnostic and/or treatment services prior to registration in the program will not be issued.
  • Contact Toronto Public Health at 416-338-7600 for more information.