Fee Navigator

    Health Service Code 03.05A

    Intensive care unit visit per 15 minutes

    NOTE:
    1. Time spent with a patient must be claimed on a cumulative basis per day.
    2. When a consultation is claimed in association with 03.05A during the same encounter, the consultation is considered to occupy the first 30 minutes of time spent with the patient.
    3. Time spent performing procedures should be excluded from the cumulative time spent with the patient per day.
    4. When a procedure and 03.05A are provided during the same encounter, only the greater benefit may be claimed.
    5. Conditions for unscheduled services apply as per GR 15.7.
    Category:V Visit
    Base rate:$57.76

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CALLM151 - 40For Each Call Pay Base At100%
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70

    Governing Rules:

    • 2.3.2

      Cumulative time is calculated by adding the total time spent delivering patient care as identified in the description of the HSC, over the course of the day (GR 1.19) and dividing the total time by the time units specified in the HSC to determine the appropriate number of calls. When the remainder of the time calculation equals less than half of one call, an additional call may not be claimed. Separate encounters may only be claimed when a special call for attendance has been made on the patient's behalf.

    • 5.3.6

      Procedures performed in ICU are payable as follows:

      1. the same encounter - the greater procedure at 100% and other procedures at 75% unless otherwise specified in the Schedule.
      2. to obtain payment at 100% for two or more procedures on the same date of service, the claim must indicate that the service was performed at a separate encounter.
    • 15.9

      The unscheduled service benefit (modifier SURC) may be claimed for the services outlined in GRs 15.9.1 through 15.9.3.

    • 15.9.1

      selected "V" category code services:

      1. consultations, including telehealth (except those provided using store and forward videotechnology);
      2. intensive care unit visits (HSC 03.05A);
      3. psychiatric mental status determination requiring complete mental health status examination and investigation (HSC 08.11A);
      4. for complex patient, requiring complete mental status examination and investigation (HSC 08.11C);
      5. certification under the Mental Health Act (HSC 08.12A);
      6. trauma assessment, multiple trauma, severely injured patient (HSC 13.99GA);
      7. hyperbaric oxygen therapy detention time (HSC 13.99I);
      8. medical emergency detention (HSC 13.99J);
      9. management of complex labor, per 15 minutes (HSC 13.99JA);
      10. donor maintenance prior to cadaveric harvesting of organs (HSC 13.99L);
      11. examination and crisis counseling for sexual/physical abuse (HSC 13.99V);
      12. attendance at delivery (HSC 87.98E).