Fee Navigator®

    Health Service Code 03.03FV

    Repeat office visit or scheduled outpatient visit, referred cases only via telephone or secure videoconference.

    NOTE:
    1. At a minimum a physician must complete a limited assessment of a patient's condition requiring a history related to the presenting problems, appropriate records, and advice to the patient. The assessment must last a minimum of 10 minutes. An assessment that does not meet the minimum requirements or is less than 10 minutes must be claimed using 03.01AD.
    2. May only be claimed by pediatrics (including subspecialties) and clinical immunology and allergy for patients 18 years of age and under, or by cardiology, endocrinology/metabolism, gastroenterology, infectious diseases, internal medicine, hematology, medical genetics, medical oncology, neurology, physiatry, respiratory medicine, rheumatology, urology and vascular surgery (no age restriction).
    3. May only be claimed if the service is personally rendered by the physician.
    4. The patient's record must include a detailed summary of all services provided including time spent and start and stop times.
    5. Only time spent communicating with the patient can be claimed as part of the service. Time spent on administrative tasks cannot be claimed.
    6. May not be claimed on the same day as 03.01AD, 03.01S, 03.01T, 03.03CV, 03.05JR, 03.08CV, 08.19CV, 08.19CW, or 08.19CX by the same physician for the same patient.
    7. May not be claimed on the same day as an in-person visit or consultation service by the same physician for the same patient.
    8. May only be claimed when a declaration of a public health emergency is made pursuant to 52.1(1), of the Public Health Act; or when the Chief Medical Officer of Health determines, in their discretion, that it is appropriate to implement this health service code even though a public health emergency has not been declared.
    Category:V Visit
    Base rate:$32.34

    AMA billing tips:

      • Patient initiated means that the patient or their agent requested to see the physician. If there are accommodations that need to be made in order to facilitate the request such as the physician calling the patient at a specific time, the service can still be claimed.
      • "referred patients" means the patient was initially referred to a physician and the physician is continuing to care for the patient for their condition.
      • Record the start and stop time of the service in the patient record
      • Must include a limited assessment of the patients condition. You must document all elements of the service, in the event of an audit, AH will reduce the claim to the lowest valued service.
      • The service MUST last 10 or more minutes - if less than 10 minutes bill 03.01AD
      • 03.03FA, complex modifiers or time premium are NOT billable in addition to this service.
      • Only specialists that have a skill code listed can bill for the service.
      • Service must be provided by a physician
      • Will not count towards the daily cap.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLCARDReplace Base$103.25
    SKLLCLIMReplace Base$63.58
    SKLLCRCMReplace Base$32.34
    SKLLE/MReplace Base$80.13
    SKLLGASTReplace Base$65.95
    SKLLHEMReplace Base$63.58
    SKLLIDISReplace Base$59.99
    SKLLINMDReplace Base$63.58
    SKLLMDGNReplace Base$100.20
    SKLLMDONReplace Base$63.58
    SKLLNEPHReplace Base$87.67
    SKLLNEURReplace Base$67.23
    SKLLNPMReplace Base$100.20
    SKLLPDGEReplace Base$100.20
    SKLLPDNRReplace Base$100.20
    SKLLPEDReplace Base$100.20
    SKLLPEDCReplace Base$103.25
    SKLLPEDNReplace Base$100.20
    SKLLPHMDReplace Base$115.27
    SKLLRHEUReplace Base$66.30
    SKLLRSMDReplace Base$98.95
    SKLLUROLReplace Base$51.34
    SKLLVSSGReplace Base$50.17

    Governing Rules:

    No Governing Rules.