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    Health Service Code 03.05O

    Direct management, reassessment, education and/or general counselling of a patient with chronic pain, per 15 minutes or portion thereof

    NOTE:

    In those situations where the physician is not part of a comprehensive, coordinated, interdisciplinary chronic pain program, the patient must have been initially assessed at an interdisciplinary chronic pain program, the name of which must be identified in the patient's chart when the patient is referred back to the home community for ongoing treatment.

    Category:V Visit
    Base rate:$44.90

    AMA billing tips:

    • Update Jan 21, 2019 -The Base Rate for this code has been corrected, claims for services for 03.05O between November 1, 2018 and Jan 21, 2019 will be reassessed and paid at the corrected rate in May 2019.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLANESReplace Base$44.90
    SKLLGPReplace Base$47.54
    CALLM151 - 99For Each Call Pay Base At100%
    TELETELESYesIncrease Base To120%

    Governing Rules:

    • 4.2.5

      Chronic Pain: Defined as pain which persists past the normal time of healing, is associated with protracted illness or is a severe symptom of a recurring condition. Interdisciplinary Chronic Pain Program: Defined as a comprehensive, coordinated, interdisciplinary program for persons complaining of chronic

      pain. The interdisciplinary team consists of a medical director; other team members will include psychologist(s) and/or psychiatrist(s), physiotherapist(s) and/or occupational therapist(s) and may include anesthetist(s) and other professional personnel. Treatment is delivered by a coordinated team within the same site by an interdisciplinary chronic pain program.