Fee Navigator®

    Health Service Code 03.01NM

    Patient care advice to a pharmacist provided via telephone or other telecommunication methods in relation to the care and treatment of a patient

    1. It is expected that the purpose of the communication will be to seek the advice/opinion or to inform a physician when changes such as but not limited to prescription adaptations, pharmacist initiated prescriptions, care plans or medication reviews have occurred.
    2. May only be claimed when the pharmacist has initiated the communication and the physician has provided an opinion or recommendation for patient treatment.
    3. May not be claimed where the primary purpose of the communication is to clarify, decipher or interpret the physician's handwriting and/or written instructions.
    4. May not be claimed for the authorization of repeat prescriptions for which long-term repeats would more properly have been authorized at the time of writing the initial prescription.
    5. May not be claimed for instances where a physician directs a patient to request the pharmacist to contact the physician.
    6. May not be claimed for patients in an active treatment, auxiliary, or nursing home facility.
    7. May not be claimed when a physician proxy, e.g. nurse or clerk, provides advice to the pharmacist.
    8. A maximum of one (1) communication per patient per day may be claimed, regardless of the number of issues or concerns discussed with the pharmacist.
    9. Where more than one patient is discussed in a single communication, a claim may be submitted with respect to each patient discussed.
    10. May be claimed in addition to visits or other services provided on the same day, by the same physician.
    11. To be claimed using the Personal Health Number of the patient.
    12. Documentation of the communication must be recorded in their respective records.
    Category:V Visit
    Base rate:$18.10

    AMA billing tips:

    • This code may be claimed when the physician receives the request and or responds by fax, email or telephone.

      GR 1.26 Telecommunications means communication via telephone, facsimile or email.

    • 03.01NM may only be claimed when the call/fax/email is initiated by the pharmacist.

      To clarify what is meant by Note 4, if a physician authorizes a short term refill until the patient can come in for an appointment, this would be acceptable. If the physician is refilling a prescription every three months over the phone instead of seeing the patient, this would NOT be billable as 03.01NM or any other service under the SOMB.

    Fee modifiers:

    No modifiers.

    Governing Rules:

    No Governing Rules.