Fee Navigator®

    Health Service Code 03.05JJ

    Professional communication/discussion with allied health professionals, educational or other community agencies on behalf of a specific patient, full 5 minutes or major portion thereof for the first call when only one call is claimed

    1. May only be claimed by:
      • pediatricians (including subspecialties) for patients 18 years of age and under;
      • medical geneticists (no age restriction).
    2. May only be claimed:
      • when the communication is initiated by the allied health, educational or community agency;
      • for services related to school difficulties, learning disorders, behavioural problems, psychiatric disorders, developmental disorders, major chronic disease, pre-transplant donor/recipient assessment, multiple handicap disorders, child abuse or neglect.
    3. May be claimed:
      • for communication provided in person, by telephone or other telecommunication methods;
      • in addition to visits or other services provided on the same day by the same physician.
    4. A maximum benefit of 60 minutes or 12 calls per physician, per week, applies.
    5. This service is to be claimed using the Personal Health Number of the patient.
    6. Documentation of the communication must be recorded in the patient record.
    Category:V Visit
    Base rate:$34.16

    AMA billing tips:

    • This code may be claimed when the physician receives the request and or responds by fax, email or telephone.

      GR 1.26 Telecommunications means communication via telephone, facsimile or email.

    • This team conference may be claimed when provided via telephone or secure videoconference.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CALLM051 - 12For Each Call Pay Base At100%

    Governing Rules: