Fee Navigator®

    Health Service Code 03.03AZ

    Limited assessment of a patient's condition requiring a history related to the presenting problems, an examination of the relevant body systems, appropriate records, and advice to the patient - out of office.

    NOTE:
    1. Benefit includes the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient.
    2. May not be claimed in addition to HSC 03.05JB at the same encounter.
    Common terms:
    • removal of sutures
    Category:V Visit
    Base rate:$18.50

    AMA billing tips:

      • Physicians that provide care in publicly funded sites are required to bill the "Z" codes.
      • Publicly funded facility types are: acute care centres, ambulatory care centres, auxiliary hospital, Health Canada Nursing Station, nursing home, regional contracted practitioner office (offices that are contracted by AHS to provide specific services) and subacute auxiliary hospital.
      • Physicians that have an overhead arrangement with AHS and are required to bill the "Z" codes should get in touch with their Zone Medical Director to make arrangements to avoid "paying" overhead twice.
      • Please consult the Alberta Health Facility Directory for information regarding facility designations.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLANESReplace Base$25.63
    SKLLANPAReplace Base$27.77
    SKLLCARDReplace Base$37.35
    SKLLCLIMReplace Base$42.84
    SKLLCMSPReplace Base$42.84
    SKLLCRSGReplace Base$27.18
    SKLLCTSGReplace Base$27.18
    SKLLDERMReplace Base$30.87
    SKLLDIRDReplace Base$18.50
    SKLLE/MReplace Base$33.72
    SKLLEMSPReplace Base$30.63
    SKLLFTERReplace Base$30.63
    SKLLGASTReplace Base$52.10
    SKLLGNSGReplace Base$25.67
    SKLLGPReplace Base$31.00
    SKLLHEMReplace Base$42.84
    SKLLHEPAReplace Base$27.77
    SKLLIDISReplace Base$49.99
    SKLLINMDReplace Base$42.84
    SKLLMDBIReplace Base$27.77
    SKLLMDGNReplace Base$42.08
    SKLLMDMIReplace Base$27.77
    SKLLMDONReplace Base$42.84
    SKLLNCMDReplace Base$18.50
    SKLLNEPHReplace Base$67.07
    SKLLNEURReplace Base$35.50
    SKLLNPMReplace Base$42.08
    SKLLNUPAReplace Base$27.77
    SKLLNUSGReplace Base$26.45
    SKLLOBGYReplace Base$29.25
    SKLLOCMDReplace Base$42.84
    SKLLOPHTReplace Base$36.71
    SKLLORTHReplace Base$25.88
    SKLLOTOLReplace Base$28.80
    SKLLOVACReplace Base$36.71
    SKLLPATHReplace Base$27.77
    SKLLPDGEReplace Base$52.10
    SKLLPDNRReplace Base$42.08
    SKLLPDSGReplace Base$42.08
    SKLLPEDReplace Base$42.08
    SKLLPEDCReplace Base$42.08
    SKLLPEDNReplace Base$67.07
    SKLLPHMDReplace Base$46.91
    SKLLPLASReplace Base$42.91
    SKLLPSYCReplace Base$30.97
    SKLLRHEUReplace Base$31.66
    SKLLROSPReplace Base$22.82
    SKLLRSMDReplace Base$46.85
    SKLLTHORReplace Base$31.86
    SKLLUROLReplace Base$41.07
    SKLLVSSGReplace Base$19.82
    AGEG75GPIncrease Base To120%
    CARECMXV15YesIncrease Base By$15.70
    CARECMXV20YesIncrease Base By$15.70
    CARECMXV30YesIncrease Base By$31.43
    CARECMXV35YesIncrease Base By$31.43
    CMPXCMGP1 - 10YesFor Each Call Increase By$18.48
    TELETELESYesIncrease Base To120%

    Governing Rules:

    • 1.31

      "Active Practice" is defined as a physician that has fulfilled both of the following criteria in the previous 12 months:

      1. 5 or more procedures where the physician is acting as the primary surgeon AND
      2. the physician has submitted claims and provided at least 10 or more of either or any combination of the following HSCs: 03.03A, 03.03AZ, 03.07A, 03.07AZ, 03.07B, 03.08A or 03.08AZ.
    • 1.33

      An "in office" service is defined as a service that is not provided in the following publically funded facility types: Active Treatment Centre, Ambulatory Care Centre, Auxiliary Hospital, Health Canada Nursing Station, Community Ambulatory Care Centre, Community Mental Health Clinic, Nursing Home, Regional Contracted Practitioner Office and Subacute Auxiliary Hospitals. The following Health Service Codes are designated as "in office": 03.03A, 03.03B, 03.03F, 03.04A, 03.05I, 03.07A, 03.08A, 03.08B, 03.08I, 03.08J, 08.19A, 08.19G, 08.19GA, and 08.45.

      An "out of office" service is defined as a service that is provided in the following publically funded facility types: Active Treatment Centre, Ambulatory Care Centre, Auxiliary Hospital, Health Canada Nursing Station, Community Ambulatory Care Centre, Community Mental Health Clinic, Nursing Home, Regional Contracted Practitioner Office and Subacute Auxiliary Hospitals. The following Health Service Codes are designated as "out of office": 03.03AZ, 03.03BZ, 03.03FZ, 03.04AZ 03.05IZ, 03.07AZ, 03.08AZ, 03.08BZ, 03.08IZ, 03.08JZ, 08.19AZ, 08.19GZ, and 08.45Z

    • 4.12.4

      Routine follow-up visits provided for a premature infant after 90 days and 180 days of age may each be claimed under HSC 03.03A or 03.03AZ.

    • 4.13.6

      Routine follow-up visits provided for a premature infant after 90 days and 180 days of age may each be claimed under HSC 03.03A, 03.03AZ or its equivalent.

    • 5.2.3

      Services provided to additional patients seen during the same callback, or services over the limits specified in GR 15.11 may be claimed as:

      1. Deleted
      2. HSC 03.02A, 03.03A, 03.03AZ, 03.03B, 03.03BZ, 03.04A, 03.04AZ as appropriate, or
      3. the applicable procedure.
    • 9.1.3

      Three technical services and three interpretive services from the following examinations may be claimed in addition to HSCs 03.02A, 03.03A, 03.03AZ, 03.07A, 03.07AZ, and 03.07B:

      • 03.12A Intraocular pressure measurement
      • 09.01A Biomicroscopy (slit lamp examination)
      • 09.01B Gonioscopy
      • 09.01C Orthoptic analysis, interpretation
      • 09.01E Orthoptic analysis, technical (may include Hess screen)
      • 09.02B Anterior chamber depth measurement
      • 09.02E Amblyopia evaluation for patients nine years of age or younger
      • 09.05A Full threshold perimetric examination, technical
      • 09.05B Full threshold perimetric examination, interpretation
      • 09.06A Color vision test, interpretation and technical
      • 09.11A Bilateral specular microscopy for corneal graft patients only - technical
      • 09.11B Bilateral specular microscopy for corneal graft patients only - interpretation
      • 09.11C Potential acuity measurement (PAM)
      • 09.12A Intravenous fluorescein angiography (IVFA), interpretation
      • 09.12B Intravenous fluorescein angiography (IVFA), technical
      • 09.13E Optical coherence tomography (OCT), interpretation
      • 09.13F Optical coherence tomography (OCT), technical
      • 09.26A Diurnal tension curve
      • 09.26D Bilateral corneal pachymetry
      • 21.31A Diagnostic irrigation of nasolacrimal duct, office procedure, per eye
      • 24.89B Diagnostic conjunctival scraping
      • 25.81A Diagnostic corneal scraping
    • 10.4.1

      Pre-operative services shall be claimed under the appropriate hospital or office visit HSCs (generally HSCs 03.03A, 03.03AZ, 03.04A, 03.04AZ, 03.04C, 03.04M) and;

    • 15.5

      Only one unscheduled service or special callback benefit may be claimed for each encounter with a patient. In the event of a special callback, the following visit services may be claimed in addition: