| Category: | V Visit |
|---|---|
| Base rate: | $32.54 |
When providing psychotherapy and non psychotherapy services at the same encounter, only ONE claim for a visit service may be submitted for payment. Either the psychotherapy service or the visit service (03.03A, 03.03AZ, 03.03F, 03.03FZ etc.). The claim should reflect the service where the majority of the time was spent providing services. Reminder that 08.19G and 08.19GZ only include direct face-to-face time, extended time may not be claimed for indirect services.
| Type | Code | # of calls | Explicit | Action | Amount |
|---|---|---|---|---|---|
| SKLL | CARD | Replace Base | $103.25 | ||
| SKLL | CLIM | Replace Base | $64.94 | ||
| SKLL | CRCM | Replace Base | $32.54 | ||
| SKLL | E/M | Replace Base | $82.15 | ||
| SKLL | GAST | Replace Base | $68.00 | ||
| SKLL | HEM | Replace Base | $64.94 | ||
| SKLL | IDIS | Replace Base | $61.07 | ||
| SKLL | INMD | Replace Base | $64.94 | ||
| SKLL | MDGN | Replace Base | $102.26 | ||
| SKLL | MDON | Replace Base | $64.94 | ||
| SKLL | NEPH | Replace Base | $87.88 | ||
| SKLL | NEUR | Replace Base | $79.74 | ||
| SKLL | NPM | Replace Base | $102.26 | ||
| SKLL | PDGE | Replace Base | $102.26 | ||
| SKLL | PDNR | Replace Base | $102.26 | ||
| SKLL | PED | Replace Base | $102.26 | ||
| SKLL | PEDC | Replace Base | $103.25 | ||
| SKLL | PEDN | Replace Base | $102.26 | ||
| SKLL | PHMD | Replace Base | $117.28 | ||
| SKLL | RHEU | Replace Base | $69.73 | ||
| SKLL | RSMD | Replace Base | $98.95 | ||
| SKLL | UROL | Replace Base | $52.00 | ||
| SKLL | VSSG | Replace Base | $50.17 | ||
| CARE | CMXV15 | Yes | Increase Base By | $15.74 | |
| CARE | CMXV20 | Yes | Increase Base By | $15.74 | |
| CARE | CMXV30 | Yes | Increase Base By | $31.51 | |
| CARE | CMXV35 | Yes | Increase Base By | $31.51 | |
| TELE | TELES | Yes | Increase Base To | 120% |
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
Limited Visit: A limited assessment, of a patient, which includes a history limited to and related to the presenting problem, and an examination which is limited to relevant body systems, an appropriate record, and advice to the patient. It includes the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient.
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* | 03.03FT* 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 |
| 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 |
If the provisions of GR 4.4.5 apply, a benefit may be claimed by the referring physician only after the full responsibility for the care of the patient has been returned to him/her, or the complexity of the clinical needs of the patient require the services of the referring physician in addition to those of the consultant.
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.
If a service is provided in a hospital emergency department, AACC or UCC, only the minor procedure or the visit benefit, whichever is the greater, may be claimed, unless the problems are emergencies and the diagnoses are unrelated.
A procedure benefit includes removal of sutures. The physician who placed sutures may not claim for removing them. A second physician who is in the same practice group as the surgeon may not claim for removing the sutures either. However, a second physician may claim a visit for removal of sutures if he is not a member of the same practice group as the practitioner who put the sutures in.
