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, 03.03AZ, 03.03B, 03.03BZ, 03.04A, 03.04AZ, 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.
• 15.11.3

  A maximum of fifteen (15) HSC 03.03LA, 03.05R or any combination thereof may be claimed, per physician, on any day of the weekend or statutory holiday, (0700 - 2200 hours).