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    Health Service Code 03.05R

    Special callback to hospital inpatient, weekends and statutory holidays 0700-2200 hours

    NOTE:
    1. May only be claimed when a special call for attendance is made on the patient's behalf.
    2. Benefits are payable based on the time at which the encounter commences.
    3. The physician responds to such a call from outside the hospital, on an unscheduled basis.
    4. The patient is attended on a priority basis.
    5. There is direct attendance by the physician.
    6. Second or subsequent patients seen during the same callback are not eligible for benefits under HSCs 03.05N, 03.05P, 03.05QA, 03.05QB or 03.05R but may be claimed using HSC 03.03AR.
    7. May not be claimed in association with any HSC except HSC 03.01AA or 03.03DF. Refer to GR 15.8.
    8. Special callback benefits (03.05N, 03.05P, 03.05QA, 03.05QB or 03.05R) should be claimed in addition to HSC 03.03DF.
    Category:V Visit
    Base rate:$113.38

    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.
    • 15.11.3

      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).