Fee Navigator

    Health Service Code 03.05QA

    Special callback to hospital inpatient, (2200-2400 hours)

    NOTE:

    Refer to notes following 03.05R.

    Category:V Visit
    Base rate:$151.16

    AMA billing tips:

    • Maximums that include both callbacks to in- and outpatients per physician per day apply:

      • 03.03KA or 03.05N — Maximum five or any combination on any weekday (07:00-17:00 hours).
      • 03.03LA or 03.05P — Maximum five or any combination on any weekday (17:00-22:00 hours).
      • 03.03LA or 03.05R — Maximum 15 or any combination on any weekend day or statutory holiday (07:00-17:00 hours).
      • 03.03MC or 03.05QA — Maximum two or any combination any day (22:00-24:00 hours).
      • 03.03MD or 03.05QB — Maximum seven or any combination any day (24:00-07:00 hours).

    Fee modifiers:

    No modifiers.

    Governing Rules:

    • 15.3 UNSCHEDULED SERVICES/SPECIAL CALLBACKS - AACC, UCC, HOSPITAL INPATIENT, OUTPATIENT AND EMERGENCY DEPARTMENTS

      Benefits for UNSCHEDULED services (modifier SURC) and special callback HSCs 03.03LA, 03.03MC, 03.03MD, 03.05P, 03.05QA, 03.05QB and 03.05R are intended to cover a degree of disruption that a physician would have to experience to provide such services during:

      • the evening on weekdays (1700 - 2200 hours),
      • the day and evening on weekends and statutory holidays (0700 - 2200 hours)
      • any night of the week (2200 - 0700 hours)
    • 15.5

      Only one unscheduled service or special callback benefit may be claimed for each encounter with a patient. In the event of a special callback, the following visit services may be claimed in addition: HSC 03.02A, 03.03A, 03.03B, 03.04A, 03.03DF or 03.03EA.

    • 15.6

      The unscheduled service and special callback benefit must be claimed according to the time at which the encounter commences and not from the time of the call for attendance.

    • 15.7.2

      Claims for special callbacks must meet all of the following conditions:

      1. a special call for attendance is made on the patient's behalf;
      2. the physician responds to such a call from outside the hospital, auxiliary hospital, nursing home, AACC or UCC on an unscheduled basis;
      3. the patient is attended on a priority basis;
      4. there is direct attendance by the physician.
    • 15.8

      Special callback benefits may not be claimed for subsequent patients seen during the same callback or in association with another service during the same encounter. However:

      1. HSC 03.03AR may be claimed for second and subsequent hospital inpatients.
      2. for second and subsequent emergency/outpatients, or AACC or UCC patients seen during the same callback, see GR 5.2.3.
      3. HSCs 03.03DF and 03.03EA may be claimed in addition to a callback in accordance with GR 15.5.
    • 15.11.4

      A maximum of two (2) HSC 03.03MC, 03.05QA or any combination thereof may be claimed, per physician, any day, (2200 - 2400 hours).