Fee Navigator®

    Health Service Code 03.05W

    Second and subsequent physician attendance at a formal, scheduled, professional interview relating to the care and treatment of a patient with chronic pain with other physicians, family, and/or direct therapeutic supervision of allied health professionals or community agencies, on behalf of a specific patient, per 15 minutes

    1. This service is to be claimed in the name of the patient.
    2. 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:$27.39

    AMA billing tips:

    • This team conference may be claimed when provided via telephone or secure videoconference.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CALLM151 - 96For Each Call Pay Base At100%
    TELETELESYesIncrease Base To120%

    Governing Rules:

    • 2.8.1

      Team conferences related to the care and treatment of a patient with other physician(s), allied health professionals, educational, correctional, and other community agencies may be claimed if provided via telephone or secure videoconference. Such services include 03.05JA, 03.05JD, 03.05JJ, 03.05JM, 03.05JN, 03.05T, 03.05U, 03.05V, 03.05W, 03.05Y, 03.05YM, 08.19F, 08.19H, 08.19J, and 08.19K.

    • 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.