Fee Navigator®

    Health Service Code 03.01AD

    Telephone advice to a patient or their agent (agent as defined in the Personal Directives Act), during a viral epidemic

    1. May only be claimed when a declaration of a public health emergency is made pursuant to 52.1(1), of the Public Health Act; or when the Chief Medical Officer of Health determines, in their discretion, that it is appropriate to implement this health service code even though a public health emergency has not been declared.
    2. May only be claimed once per patient, per physician, per day.
    3. Benefit includes providing a new prescription or prescription renewal if provided.
    4. May not be claimed for providing general information on the virus.
    5. May not be claimed for services provided through Health Link.
    6. Documentation of the request and advice given must be recorded.
    7. May only be claimed when communication is provided by the physician.
    Category:V Visit
    Base rate:$20.00

    AMA billing tips:

    • Depending on your software, Dx code 079.82 or 079.8 must be on the claim, 079.8 is not accurate but will be accepted.

      • To be used if the virtual service is less than 10 minutes.
      • If the physician and or the patient are exercising social distancing, the 03.01AD may be claimed to address ANY medical condition using 03.01AD even if it is not related to COVID-19. The reason that the call is taking place instead of an in person visit is due to COVID-19 therefore the first Dx code on the claim must be 079.82 or 079.8, the second Dx code on the claim must reflect the other medical condition.
      • The physician MUST be the one making the call
      • Only one per patient per physician per day
      • Billed using the PHN of the patient
      • Use the location of the physician at the time of the call
      • Document the call, the request that was made and the advice given and to whom the advice was given
      • Document the start and stop time of the service in the patient record. May not be billed:
      • When leaving a message
      • When the nurse provides the service

      03.01AD will not count towards the daily cap of "V" Category codes

    Fee modifiers:

    No modifiers.

    Governing Rules:

    No Governing Rules.