Governing Rules:

• 5.2.1

  HSCs 03.03KA, 03.03LA, 03.03MC and 03.03MD may be claimed when a physician is specially called from home or office to a hospital emergency department, AACC or UCC to attend one patient. Maximums apply, see GR 15.11.

• 5.2.2

  If a physician is in a hospital, AACC or UCC for any purpose and is asked to see another patient in the hospital emergency room or the same AACC or UCC, HSCs 03.03KA, 03.03LA, 03.03MC, 03.03MD do not apply. Benefits may be claimed for the applicable visit or procedure.

• 15.3 UNSCHEDULED SERVICES/SPECIAL CALLBACKS - AACC, UCC, HOSPITAL INPATIENT, OUTPATIENT AND EMERGENCY DEPARTMENTS

  Benefits for UNSCHEDULED services (modifier SURC) and special callback HSCs 03.03LA, 03.03MC, 03.03MD, 03.05P, 03.05QA, 03.05QB and 03.05R are intended to cover a degree of disruption that a physician would have to experience to provide such services during:

  • the evening on weekdays (1700 - 2200 hours),
  • the day and evening on weekends and statutory holidays (0700 - 2200 hours)
  • any night of the week (2200 - 0700 hours)
• 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:

  • HSC 03.02A, 03.03A, 03.03AZ, 03.03B, 03.03BZ, 03.04A, 03.04AZ, 03.03DF or
  • 03.03EA.
• 15.6

  The unscheduled service and special callback benefit must be claimed according to the time at which the encounter commences and not from the time of the call for attendance.

• 15.7.2

  Claims for special callbacks must meet all of the following conditions:

  1. a special call for attendance is made on the patient's behalf;
  2. the physician responds to such a call from outside the hospital, auxiliary hospital, nursing home, AACC or UCC on an unscheduled basis;
  3. the patient is attended on a priority basis;
  4. there is direct attendance by the physician.
• 15.8

  Special callback benefits may not be claimed for subsequent patients seen during the same callback or in association with another service during the same encounter. However:

  1. HSC 03.03AR may be claimed for second and subsequent hospital inpatients.
  2. for second and subsequent emergency/outpatients, or AACC or UCC patients seen during the same callback, see GR 5.2.3.
  3. HSCs 03.03DF and 03.03EA may be claimed in addition to a callback in accordance with GR 15.5.
• 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).