Fee Navigator®

    Health Service Code 03.05Y

    Formal, scheduled, professional interview, case conference with other physicians and/or direct therapeutic supervision of allied health professionals, educational or other community agencies on behalf of a specific patient, provided by the physician most responsible for the patient's care.

    1. May not be claimed unless the physician has seen the patient and been directly involved in the patient's care.
    2. May only be claimed by:
      • pediatricians (including subspecialties) for patients 18 years of age and under
      • medical geneticists and psychiatrists (no age restriction) when a minimum of 30 minutes has been spent.
    3. A maximum benefit of 3 hours applies per session.
    4. A maximum benefit of 6 hours per patient, per physician, per benefit year, applies.
    5. This service is to be claimed using the Personal Health Number of the patient.
    6. HSC 03.03D may be claimed on the same day.
    Category:V Visit
    Base rate:$101.28

    AMA billing tips:

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

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CALLM301 - 6For Each Call Pay Base At100%
    TELETELESYesIncrease Base To120%

    Governing Rules: