Fee Navigator®

    Health Service Code 03.05LB

    Group teaching session for patients and/or family members with chronic pain, previous amputation, stroke, brain injury, concussion, spinal cord injury, or other neuromusculoskeletal condition, first 45 minutes or major portion thereof for the first call when only one call is claimed

    NOTE:

    May not be claimed for preparation time.

    Category:V Visit
    Base rate:$253.60

    AMA billing tips:

    • 03.05LB may only be claimed by physiatrists (PHMD skill code).

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    NBPGNBPGYesReduce Base To
    CALLM45M151For Each Call Pay Base At100%
    CALLM45M152 - 32For Each Call Pay Base At20%

    Governing Rules:

    • 19.1

      Daily patient volume payment rules will apply to visit services with a "V" category code (excluding HSC 03.01AD, 03.01N, 03.03CV, 03.03FV, 03.05LB, 03.08CV, 08.19CV, 08.19CW, 08.19CX, 08.44A, 08.44B, 08.44C, 08.44D, 13.59V, 13.59VA, 13.82A, 13.99AC, 13.99O and 13.99OA) that are provided in an office, home, or a non-registered facility.

      Excluding Grande Prairie and Fort McMurray, the daily patient volume payment rules will not apply to services provided in communities that are eligible for variable fee payments under the Rural Remote Northern Program.

      The total of all billings for eligible category "V" codes that are accepted for payment under the Alberta Health Care Insurance Plan will be calculated for each practitioner for each calendar day. When the daily total exceeds 50, the practitioner's payment on the category "V" codes that exceed 50 will be discounted by 50 percent. When the daily total exceeds 65, the practitioner's payment on the category "V" codes that exceed 65 will be discounted by 100 percent.

      Services will be assessed and payment/discounts will be applied to services in the order in which they are accepted for payment by the Alberta Health Care Insurance Plan.