Governing Rules

Fee Navigator®

    Governing Rule: 15.11

    MAXIMUMS FOR SPECIAL CALLBACKS

    AMA billing tips:

    • Maximums that include both callbacks to in- and outpatients per physician per day apply:

      • 03.03KA or 03.05N — Maximum five or any combination on any weekday (07:00-17:00 hours).
      • 03.03LA or 03.05P — Maximum five or any combination on any weekday (17:00-22:00 hours).
      • 03.03LA or 03.05R — Maximum 15 or any combination on any weekend day or statutory holiday (07:00-17:00 hours).
      • 03.03MC or 03.05QA — Maximum two or any combination any day (22:00-24:00 hours).
      • 03.03MD or 03.05QB — Maximum seven or any combination any day (24:00-07:00 hours).
      Read more
    • 15.11.1

      A maximum of five (5) special callbacks, either HSC 03.03KA, 03.05N or any combination thereof may be claimed, per physician, in any given weekday day. The weekday day is defined as Monday - Friday (0700 - 1700 hours).

    • 15.11.2

      A maximum of five (5) HSC 03.03LA, 03.05P or any combination thereof may be claimed, per physician, in any given weekday, Monday - Friday (1700 - 2200 hours).

    • AMA billing tips:

      • Maximums that include both callbacks to in- and outpatients per physician per day apply:

        • 03.03KA or 03.05N — Maximum five or any combination on any weekday (07:00-17:00 hours).
        • 03.03LA or 03.05P — Maximum five or any combination on any weekday (17:00-22:00 hours).
        • 03.03LA or 03.05R — Maximum 15 or any combination on any weekend day or statutory holiday (07:00-17:00 hours).
        • 03.03MC or 03.05QA — Maximum two or any combination any day (22:00-24:00 hours).
        • 03.03MD or 03.05QB — Maximum seven or any combination any day (24:00-07:00 hours).
        Read more
    • 15.11.3

      A maximum of fifteen (15) HSC 03.03LA, 03.05R or any combination thereof may be claimed, per physician, on any day of the weekend or statutory holiday, (0700 - 2200 hours).

    • AMA billing tips:

      • Maximums that include both callbacks to in- and outpatients per physician per day apply:

        • 03.03KA or 03.05N — Maximum five or any combination on any weekday (07:00-17:00 hours).
        • 03.03LA or 03.05P — Maximum five or any combination on any weekday (17:00-22:00 hours).
        • 03.03LA or 03.05R — Maximum 15 or any combination on any weekend day or statutory holiday (07:00-17:00 hours).
        • 03.03MC or 03.05QA — Maximum two or any combination any day (22:00-24:00 hours).
        • 03.03MD or 03.05QB — Maximum seven or any combination any day (24:00-07:00 hours).
        Read more
    • 15.11.4

      A maximum of two (2) HSC 03.03MC, 03.05QA or any combination thereof may be claimed, per physician, any day, (2200 - 2400 hours).

    • AMA billing tips:

      • Maximums that include both callbacks to in- and outpatients per physician per day apply:

        • 03.03KA or 03.05N — Maximum five or any combination on any weekday (07:00-17:00 hours).
        • 03.03LA or 03.05P — Maximum five or any combination on any weekday (17:00-22:00 hours).
        • 03.03LA or 03.05R — Maximum 15 or any combination on any weekend day or statutory holiday (07:00-17:00 hours).
        • 03.03MC or 03.05QA — Maximum two or any combination any day (22:00-24:00 hours).
        • 03.03MD or 03.05QB — Maximum seven or any combination any day (24:00-07:00 hours).
        Read more
    • 15.11.5

      A maximum of seven (7) HSC 03.03MD, 03.05QB or any combination thereof may be claimed, per physician, any day, (2400 - 0700 hours).

    • AMA billing tips:

      • Maximums that include both callbacks to in- and outpatients per physician per day apply:

        • 03.03KA or 03.05N — Maximum five or any combination on any weekday (07:00-17:00 hours).
        • 03.03LA or 03.05P — Maximum five or any combination on any weekday (17:00-22:00 hours).
        • 03.03LA or 03.05R — Maximum 15 or any combination on any weekend day or statutory holiday (07:00-17:00 hours).
        • 03.03MC or 03.05QA — Maximum two or any combination any day (22:00-24:00 hours).
        • 03.03MD or 03.05QB — Maximum seven or any combination any day (24:00-07:00 hours).
        Read more
    • 15.11.6

      Deleted

    • 15.11.7

      A maximum of five (5) special callbacks to a closed office, HSC 03.03ME, may be claimed, per physician, in any given weekday, Monday - Friday (0000 - 2400 hours).

    • 15.11.8

      A maximum of ten (10) special callbacks to a closed office, HSC 03.03MF may be claimed, per physician, on any day of the weekend or statutory holiday, (0000 - 2400 hours).

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