Fee Navigator

    Health Service Code 03.04C

    Hospital admission

    Category:V Visit
    Base rate:$34.05

    AMA billing tips:

    • 03.04C may not be claimed in the preoperative period by the physician performing the procedure. It is considered a visit item and will be rejected once a claim for a procedure is submitted.

      03.04C may be claimed with SUBD modifiers depicting time of day as indicated in the Price List. For hospital admissions, the modifiers indicate the time period in which the encounter took place.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLANESReplace Base$76.88
    SKLLANPAReplace Base$81.68
    SKLLCARDReplace Base$107.15
    SKLLCLIMReplace Base$198.70
    SKLLCMSPReplace Base$198.70
    SKLLCRCMReplace Base$34.05
    SKLLCRSGReplace Base$77.00
    SKLLCTSGReplace Base$77.00
    SKLLDERMReplace Base$75.53
    SKLLDIRDReplace Base$91.72
    SKLLE/MReplace Base$156.10
    SKLLGASTReplace Base$186.95
    SKLLGNSGReplace Base$95.08
    SKLLGPReplace Base$129.95
    SKLLHEMReplace Base$198.70
    SKLLHEPAReplace Base$81.68
    SKLLIDISReplace Base$149.97
    SKLLINMDReplace Base$198.70
    SKLLMDBIReplace Base$81.68
    SKLLMDGNReplace Base$200.40
    SKLLMDMIReplace Base$81.68
    SKLLMDONReplace Base$198.70
    SKLLNCMDReplace Base$91.72
    SKLLNEPHReplace Base$210.41
    SKLLNEURReplace Base$140.48
    SKLLNPMReplace Base$200.40
    SKLLNUPAReplace Base$81.68
    SKLLNUSGReplace Base$99.05
    SKLLOBGYReplace Base$98.72
    SKLLOCMDReplace Base$198.70
    SKLLOPHTReplace Base$78.08
    SKLLOTOLReplace Base$79.44
    SKLLPATHReplace Base$81.68
    SKLLPDGEReplace Base$200.40
    SKLLPDNRReplace Base$200.40
    SKLLPDSGReplace Base$200.40
    SKLLPEDReplace Base$200.40
    SKLLPEDCReplace Base$200.40
    SKLLPEDNReplace Base$210.41
    SKLLPHMDReplace Base$160.38
    SKLLPLASReplace Base$155.47
    SKLLPSYCReplace Base$91.72
    SKLLRHEUReplace Base$124.98
    SKLLROSPReplace Base$129.95
    SKLLRSMDReplace Base$155.20
    SKLLTHORReplace Base$48.56
    SKLLUROLReplace Base$102.67
    SKLLVSSGReplace Base$105.37
    CARECMXC30YesIncrease Base By$31.43
    SUBDHAEVYesIncrease Base By$43.17
    SUBDHAEVWKYesIncrease Base By$43.17
    SUBDHANTAMYesIncrease Base By$147.88
    SUBDHANTPMYesIncrease Base By$147.88

    Governing Rules:

    • 2.7.3

      For administrative purposes the start of the day is considered to be midnight. A hospital visit which takes place after 0700 hours may be claimed in addition to one of the following services provided between midnight and 0700 hours:

      1. emergency home visit and admission to a hospital and hospital visit on the same day;
      2. home visit;
      3. hospital admission or consultation claimed in lieu of hospital admission;
      4. emergency visit/special callback to hospital emergency/outpatient department, AACC or UCC, when specially called from home or office;
      5. a special call for attendance to a patient at a closed office, with no staff in attendance.
    • 4.7 OTHER LIMITATIONS ON VISIT ITEMS

      In general, when an office visit and a hospital admission are provided to a patient on the same day by the same physician, only the greater benefit may be claimed. There are two exceptions to this. Firstly, if a new condition arose and the patient was seen at two separate encounters, both services may be claimed. Information must accompany this claim. Secondly, two services may be claimed when they fall within the provisions of GR 2.7.3.

    • 4.10.5

      A physician who admits a patient to hospital and provides pre-operative care but does not perform the surgery, may claim benefits for the services up to and including the day of surgery.

    • 6.6.1

      If a patient is admitted to a hospital for the purpose of undergoing a procedure designated "+", a benefit is payable for a visit provided the day before or the day after the procedure is performed, but if the procedure is performed and a visit occurs on the same day, a benefit is payable for either the procedure or the visit, but not both.

    • 8.1.2

      Prenatal visits (HSC 03.03B), emergency, outpatient and inpatient hospital visits may be claimed up to the time of delivery, including the day of delivery; except in the situation where delivery occurs within 24 hours of admission, in which case neither a hospital admission (03.04C) nor a hospital visit (03.03D) may be claimed.

    • 8.1.5

      When a delivery occurs within 24 hours of admission, the delivery benefit includes the hospital admission (HSC 03.04C) or hospital visit (03.03D). Post-partum hospital visits, by the same or different physician, for the period of one week after the delivery, and ordinary immediate care of the newborn are also included. When there is a life threatening situation which requires neonatal resuscitation, HSC 13.99F may be claimed as well.

    • 12.2.2

      An admission visit and hospital daily care may be claimed by a family physician functioning as an anesthetist.