Fee Navigator®

    Health Service Code 03.03N

    Home visit - first patient

    NOTE:

    At a minimum, a physician must complete a 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.

    Common terms:
    • house call
    • respite care
    Category:V Visit
    Base rate:$38.19

    AMA billing tips:

    • Governing Rule 1.6 For the purposes of billing home visits, "home" includes personal residence or temporary lodging, assisted living, designated assisted living, group home, seniors' lodge, personal care home and other residences as approved, but does not include auxiliary hospitals or nursing homes.

    • 03.03N may be claimed when a visit service is performed for the first patient in the home.

      If you are visiting a patient(s) that reside in a facility that is set up in an apartment style arrangement, where there are multiple patients in individual units within the same building or complex, 03.03NA and or 03.03NB should be used.

      For services provided in an individuals home, where more than one person requires a home visit service, the second patient and subsequent patients should be billed using HSC 03.03P.

      If visits are performed for respite patients, the home visit code (03.03N) may be used as this would be considered temporary lodging.

      If visit services are performed at a facility where a room is set up for physicians to perform visit services, the 03.03N/P codes are not billable. The appropriate visit code (03.02A, 03.03A, 03.04A) should be used with location codes OTHR on the claim.

      The location code on the claim when the service is provided at the patients home is HOME. No facility number or functional centre is required, leave these fields blank.

    • The SUBD modifier MAY ONLY be claimed on home visits when a call for attendance by the physician has been made AND the physician responds on a priority basis within 24 hours of the call. When more than one patient is seen, the appropriate HSC should be used however; additional SUBD modifiers may only be claimed for additional patients when a specific call for attendance has been made for each patient.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLANESReplace Base$58.50
    SKLLANPAReplace Base$81.68
    SKLLCARDReplace Base$66.50
    SKLLCLIMReplace Base$79.48
    SKLLCMSPReplace Base$79.48
    SKLLCRCMReplace Base$55.84
    SKLLCRSGReplace Base$63.41
    SKLLCTSGReplace Base$63.41
    SKLLDERMReplace Base$56.73
    SKLLDIRDReplace Base$75.53
    SKLLE/MReplace Base$78.05
    SKLLGASTReplace Base$38.19
    SKLLGNSGReplace Base$63.39
    SKLLGPReplace Base$85.58
    SKLLHEMReplace Base$79.48
    SKLLHEPAReplace Base$81.68
    SKLLIDISReplace Base$55.99
    SKLLINMDReplace Base$79.48
    SKLLMDBIReplace Base$81.68
    SKLLMDGNReplace Base$110.22
    SKLLMDMIReplace Base$81.68
    SKLLMDONReplace Base$79.48
    SKLLNCMDReplace Base$75.53
    SKLLNEPHReplace Base$104.80
    SKLLNEURReplace Base$83.10
    SKLLNPMReplace Base$110.22
    SKLLNUPAReplace Base$81.68
    SKLLNUSGReplace Base$80.31
    SKLLOBGYReplace Base$70.96
    SKLLOCMDReplace Base$79.48
    SKLLOPHTReplace Base$59.58
    SKLLORTHReplace Base$58.89
    SKLLOTOLReplace Base$60.27
    SKLLPATHReplace Base$81.68
    SKLLPDGEReplace Base$110.22
    SKLLPDNRReplace Base$110.22
    SKLLPDSGReplace Base$110.22
    SKLLPEDReplace Base$110.22
    SKLLPEDCReplace Base$110.22
    SKLLPEDNReplace Base$110.22
    SKLLPHMDReplace Base$100.24
    SKLLPLASReplace Base$103.65
    SKLLPSYCReplace Base$69.35
    SKLLRHEUReplace Base$56.68
    SKLLROSPReplace Base$85.58
    SKLLRSMDReplace Base$80.89
    SKLLTHORReplace Base$61.04
    SKLLUROLReplace Base$75.98
    SKLLVSSGReplace Base$55.19
    SUBDOFEVYesIncrease Base By$43.79
    SUBDOFEVWKYesIncrease Base By$51.33
    SUBDOFNTAMYesIncrease Base By$117.68
    SUBDOFNTPMYesIncrease Base By$117.68
    CMPXCMGP1 - 10YesFor Each Call Increase By$18.48

    Governing Rules:

    • 6.1

      If a physician performs a minor procedure and provides a service warranting a claim for an office visit or a home visit on the same day, benefits for both may be claimed only if the services and diagnoses are unrelated.