Common terms: |
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Category: | V Visit |
Base rate: | $32.34 |
CMXV15 and CMXV20 have been added effective January 1, 2022.
Type | Code | # of calls | Explicit | Action | Amount |
---|---|---|---|---|---|
SKLL | CARD | Replace Base | $103.25 | ||
SKLL | CLIM | Replace Base | $63.58 | ||
SKLL | CRCM | Replace Base | $32.34 | ||
SKLL | E/M | Replace Base | $80.13 | ||
SKLL | GAST | Replace Base | $65.95 | ||
SKLL | HEM | Replace Base | $63.58 | ||
SKLL | IDIS | Replace Base | $59.99 | ||
SKLL | INMD | Replace Base | $63.58 | ||
SKLL | MDGN | Replace Base | $100.20 | ||
SKLL | MDON | Replace Base | $63.58 | ||
SKLL | NEPH | Replace Base | $87.67 | ||
SKLL | NEUR | Replace Base | $67.23 | ||
SKLL | NPM | Replace Base | $100.20 | ||
SKLL | PDGE | Replace Base | $100.20 | ||
SKLL | PDNR | Replace Base | $100.20 | ||
SKLL | PED | Replace Base | $100.20 | ||
SKLL | PEDC | Replace Base | $103.25 | ||
SKLL | PEDN | Replace Base | $100.20 | ||
SKLL | PHMD | Replace Base | $115.27 | ||
SKLL | RHEU | Replace Base | $66.30 | ||
SKLL | RSMD | Replace Base | $98.95 | ||
SKLL | UROL | Replace Base | $51.34 | ||
SKLL | VSSG | Replace Base | $50.17 | ||
CARE | CMXV15 | Yes | Increase Base By | $15.70 | |
CARE | CMXV20 | Yes | Increase Base By | $15.70 |
When a claim is submitted for the following HSCs, the referring practitioner field must be completed with a valid referring practitioner number.
HSCs in the following list marked with an asterisk(*) cannot be self-referred. Self-referred means the physician is providing the diagnostic service and treating the patient.
HSCs in Section E (Lab and Pathology) and X (Diagnostic Radiology) require a valid referring practitioner number with the following exceptions: HSC X27D does not require a referral and HSC X27F may be self-referred. HSC 03.03D requires a valid referring physician, chiropractor, midwife, podiatrist, dentist, optometrist, physical therapist or nurse practitioner number when it is a visit to a referred patient.
01.01A | 01.01B | 01.03 | 01.04A | 01.05A | 01.09 |
01.12A | 01.12B | 01.14 | 01.16A | 01.16B | 01.16C |
01.22 | 01.22A | 01.22B | 01.22C | 01.24A | 01.24B |
01.24BA | 01.24BB | 01.32 | 01.34 | 02.82A | 02.84A |
02.84B |
03.01O* | 03.01LJ* 03.01LK* 03.01LL* 03.03D* | 03.03F* | ||
03.03FA* | *03.03FV 03.03FZ* 03.04Q* | 03.05B* | 03.07A* | |
03.07AZ* | 03.07B* | 03.07C* | 03.08A* | 03.08AZ* 03.08B* |
03.08BZ* | 03.08C* | 03.08CV* 03.08F* | 03.08H* | 03.08K* |
03.08L* | 03.08M* |
10.04 | 10.08A | 10.33B | 13.99CC 13.99GA* | 14.49A | |
14.82 | 14.85B | 14.88A | 14.88B | 15.94A | 16.83A |
16.83B | 16.83C | 16.89A | 16.92B | 17.81B | 19.81 |
22.81 | 24.89A | 24.89B | 28.8 A | 28.81A | 29.0 A |
30.81A | 33.22B | 37.81 | 37.82A | 37.82B | 38.89A |
38.89B | 39.21A | 39.62A | 39.83A |
40.92A | 41.29A | 41.29B | 42.09B | 43.81 | 43.82 |
44.3 B | 45.81A | 45.83 | 45.84B | 45.86A | 46.5 A |
46.81A | 46.82 | 46.84A | 46.88A | 48.92A | 48.98A |
48.98B | 49.93A | 49.95A | 49.96A | 49.96B | 49.98B |
49.98C | 49.98D |
50.81A | 50.81B | 50.81C | 50.81D | 50.81E | 50.82A |
50.82B | 50.83A | 50.84A | 50.84B | 50.84C | 50.87A |
50.87B | 50.87C | 50.88A | 50.89A | 50.89B | 50.89C |
50.89D | 50.89E | 50.91B | 50.95A | 50.95B | 50.98A |
52.1 A | 52.11A | 52.12 | 52.13 | 52.85A | 53.81A |
53.81B | 53.83A | 54.89A | 54.89B | 54.89D | 54.89E |
54.89F | 57.92A |
60.82C | 60.89A | 62.12A | 62.12B | 62.81A | 63.86A |
63.96B | 64.95A | 64.97A | 66.19A | 66.3 C | 66.83 |
66.89A | 66.89B | 66.89C | 67.81 | 67.86 | 67.87A |
67.89A | 68.95 | 69.83A | 69.83B | 72.91 | 72.92A |
74.82A | 75.83A | 76.89A | 78.7 A | 79.29E |
F7 |
Daily patient volume payment rules will apply to visit services with a "V" category code (excluding HSC 03.01AD, 03.01N, 03.03CV, 03.03FV, 03.05LB, 03.08CV, 08.19CV, 08.19CW, 08.19CX, 08.44A, 08.44B, 08.44C, 08.44D, 13.59V, 13.59VA, 13.82A, 13.99AC, 13.99O and 13.99OA) that are provided in an office, home, or a non-registered facility.
Excluding Grande Prairie and Fort McMurray, the daily patient volume payment rules will not apply to services provided in communities that are eligible for variable fee payments under the Rural Remote Northern Program.
The total of all billings for eligible category "V" codes that are accepted for payment under the Alberta Health Care Insurance Plan will be calculated for each practitioner for each calendar day. When the daily total exceeds 50, the practitioner's payment on the category "V" codes that exceed 50 will be discounted by 50 percent. When the daily total exceeds 65, the practitioner's payment on the category "V" codes that exceed 65 will be discounted by 100 percent.
Services will be assessed and payment/discounts will be applied to services in the order in which they are accepted for payment by the Alberta Health Care Insurance Plan.
Disclaimer: this tool has been produced by the AMA solely as a convenient reference and the official Government of Alberta statutes and regulations must be consulted for all purposes of interpreting and applying the law. © Alberta Medical Association 2023 | Privacy Policy