May not be claimed in addition to a surgical assist (SA, SAQS, SSOS) for the same patient by the same physician.
| Category: | V Visit |
|---|---|
| Base rate: | $41.70 |
03.07A may only be claimed when all of the following criteria have been met:
Consultations may NOT be claimed for transfer of care or pre operative assessments.
| Type | Code | # of calls | Explicit | Action | Amount |
|---|---|---|---|---|---|
| SKLL | ANES | Replace Base | $59.95 | ||
| SKLL | ANPA | Replace Base | $87.79 | ||
| SKLL | CARD | Replace Base | $115.12 | ||
| SKLL | CLIM | Replace Base | $113.65 | ||
| SKLL | CMSP | Replace Base | $113.65 | ||
| SKLL | CRCM | Replace Base | $74.21 | ||
| SKLL | CRSG | Replace Base | $58.16 | ||
| SKLL | CTSG | Replace Base | $58.16 | ||
| SKLL | DERM | Replace Base | $41.70 | ||
| SKLL | E/M | Replace Base | $123.24 | ||
| SKLL | EMSP | Replace Base | $60.04 | ||
| SKLL | FTER | Replace Base | $60.04 | ||
| SKLL | GAST | Replace Base | $105.10 | ||
| SKLL | GNSG | Replace Base | $63.76 | ||
| SKLL | GP | Replace Base | $69.11 | ||
| SKLL | HEM | Replace Base | $113.65 | ||
| SKLL | HEPA | Replace Base | $87.79 | ||
| SKLL | IDIS | Replace Base | $152.68 | ||
| SKLL | INMD | Replace Base | $113.65 | ||
| SKLL | MDBI | Replace Base | $87.79 | ||
| SKLL | MDGN | Replace Base | $122.71 | ||
| SKLL | MDMI | Replace Base | $87.79 | ||
| SKLL | MDON | Replace Base | $113.65 | ||
| SKLL | NEPH | Replace Base | $112.49 | ||
| SKLL | NEUR | Replace Base | $98.93 | ||
| SKLL | NPM | Replace Base | $122.71 | ||
| SKLL | NUPA | Replace Base | $87.79 | ||
| SKLL | NUSG | Replace Base | $74.95 | ||
| SKLL | OBGY | Replace Base | $63.90 | ||
| SKLL | OCMD | Replace Base | $113.65 | ||
| SKLL | OPHT | Replace Base | $85.42 | ||
| SKLL | ORTH | Replace Base | $78.02 | ||
| SKLL | OTOL | Replace Base | $58.87 | ||
| SKLL | PATH | Replace Base | $87.79 | ||
| SKLL | PDGE | Replace Base | $122.71 | ||
| SKLL | PDNR | Replace Base | $122.71 | ||
| SKLL | PDSG | Replace Base | $122.71 | ||
| SKLL | PED | Replace Base | $122.71 | ||
| SKLL | PEDC | Replace Base | $122.71 | ||
| SKLL | PEDN | Replace Base | $122.71 | ||
| SKLL | PHMD | Replace Base | $100.24 | ||
| SKLL | PLAS | Replace Base | $51.90 | ||
| SKLL | RHEU | Replace Base | $94.22 | ||
| SKLL | RSMD | Replace Base | $95.38 | ||
| SKLL | THOR | Replace Base | $57.51 | ||
| SKLL | UROL | Replace Base | $69.33 | ||
| SKLL | VSSG | Replace Base | $100.35 | ||
| CARE | CMXV15 | Yes | Increase Base By | $15.74 | |
| CARE | CMXV20 | Yes | Increase Base By | $15.74 | |
| CARE | CMXV30 | Yes | Increase Base By | $31.51 | |
| CARE | CMXV35 | Yes | Increase Base By | $31.51 | |
| SURC | EV | Yes | Increase By | $48.82 | |
| SURC | NTAM | Yes | Increase By | $117.12 | |
| SURC | NTPM | Yes | Increase By | $117.12 | |
| SURC | WK | Yes | Increase By | $48.82 | |
| CMPX | CMGP | 1 - 10 | Yes | For Each Call Increase By | $19.19 |
| TELE | TELES | Yes | Increase Base To | 120% |
"Active Practice" is defined as a physician that has fulfilled both of the following criteria in the previous 12 months:
An "in office" service is defined as a service that is not provided in the following publically funded facility types: Active Treatment Centre, Ambulatory Care Centre, Auxiliary Hospital, Health Canada Nursing Station, Community Ambulatory Care Centre, Community Mental Health Clinic, Nursing Home, Regional Contracted Practitioner Office and Subacute Auxiliary Hospitals. The following Health Service Codes are designated as "in office": 03.03A, 03.03B, 03.03F, 03.04A, 03.05I, 03.07A, 03.08A, 03.08B, 03.08I, 03.08J, 08.19A, 08.19G, 08.19GA, and 08.45.
An "out of office" service is defined as a service that is provided in the following publically funded facility types: Active Treatment Centre, Ambulatory Care Centre, Auxiliary Hospital, Health Canada Nursing Station, Community Ambulatory Care Centre, Community Mental Health Clinic, Nursing Home, Regional Contracted Practitioner Office and Subacute Auxiliary Hospitals. The following Health Service Codes are designated as "out of office": 03.03AZ, 03.03BZ, 03.03FZ, 03.04AZ 03.05IZ, 03.07AZ, 03.08AZ, 03.08BZ, 03.08IZ, 03.08JZ, 08.19AZ, 08.19GZ, and 08.45Z
Limited Consultation: Limited assessment of a patient and a written report to the referring physician, audiologist, Alberta registered midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner. A limited consultation includes a history limited to and related to the presenting problem, and an examination which is limited to relevant body systems, an appropriate record, and advice to the patient. It may include the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient and/or the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner.
In this Schedule "consultation" means that situation where a physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner after an appropriate examination of the patient, requests the opinion of a consultant physician, and the consultant does a history, an examination and a review of the diagnostic data and provides a written opinion with recommendations as to the treatment, to the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner. Consultations may not be claimed for the transfer of care alone.
Repeat consultations may not be claimed unless a further request has been initiated by and received from the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner for another consultation. A repeat consultation may not be claimed if initiated by the consultant.
When a physician sends a member of his family to another physician, a consultation benefit may not be claimed.
When a claim is submitted for the following HSCs, the referring practitioner field must be completed with a valid referring practitioner number.
HSCs in the following list marked with an asterisk(*) cannot be self-referred. Self-referred means the physician is providing the diagnostic service and treating the patient.
HSCs in Section E (Lab and Pathology) and X (Diagnostic Radiology) require a valid referring practitioner number with the following exceptions: HSC X27D does not require a referral and HSC X27F may be self-referred. HSC 03.03D requires a valid referring physician, chiropractor, midwife, podiatrist, dentist, optometrist, physical therapist or nurse practitioner number when it is a visit to a referred patient.
| 01.01A | 01.01B | 01.03 | 01.04A | 01.05A | 01.09 |
| 01.12A | 01.12B | 01.14 | 01.16A | 01.16B | 01.16C |
| 01.22 | 01.22A | 01.22B | 01.22C | 01.24A | 01.24B |
| 01.24BA | 01.24BB | 01.32 | 01.34 | 02.82A | 02.84A |
| 02.84B |
| 03.01O* | 03.01LJ* 03.01LK* 03.01LL* 03.03D* | 03.03F* | ||
| 03.03FA* | 03.03FT* 03.03FV* 03.03FZ* 03.04Q* | 03.05B* | ||
| *03.07A | 03.07AZ* 03.07B* | 03.07C* | 03.08A* | 03.08AZ* |
| 03.08B* | 03.08BZ* 03.08C* | 03.08CV* 03.08F* | 03.08H* | |
| 03.08K* | 03.08L* | 03.08M* |
| 10.04 | 10.08A | 10.33B | 13.99CC 13.99GA* | 14.49A | |
| 14.82 | 14.85B | 14.88A | 14.88B | 15.94A | 16.83A |
| 16.83B | 16.83C | 16.89A | 16.92B | 17.81B | 19.81 |
| 22.81 | 24.89A | 24.89B | 28.8 A | 28.81A | 29.0 A |
| 30.81A | 33.22B | 37.81 | 37.82A | 37.82B | 38.89A |
| 38.89B | 39.21A | 39.62A | 39.83A |
| 40.92A | 41.29A | 41.29B | 42.09B | 43.81 | 43.82 |
| 44.3 B | 45.81A | 45.83 | 45.84B | 45.86A | 46.5 A |
| 46.81A | 46.82 | 46.84A | 46.88A | 48.92A | 48.98A |
| 48.98B | 49.93A | 49.95A | 49.96A | 49.96B | 49.98B |
| 49.98C | 49.98D |
| 60.82C | 60.89A | 62.12A | 62.12B | 62.81A | 63.86A |
| 63.96B | 64.95A | 64.97A | 66.19A | 66.3 C | 66.83 |
| 66.89A | 66.89B | 66.89C | 67.81 | 67.86 | 67.87A |
| 67.89A | 68.95 | 69.83A | 69.83B | 72.91 | 72.92A |
| 74.82A | 75.83A | 76.89A | 78.7 A | 79.29E |
| F7 |
A limited consultation may be claimed when dealing with one particular problem and shall include interpretation of laboratory tests, and a written report to the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner who must care for the patient in the future. A claim for a limited consultation may be made when there is a written request or other documented communication from the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist, nurse
practitioner or their agent for an opinion or treatment by the emergency physician.
If newborn and premature care is provided by a pediatrician,
Three technical services and three interpretive services from the following examinations may be claimed in addition to HSCs 03.02A, 03.03A, 03.03AZ, 03.07A, 03.07AZ, and 03.07B:
When done independently on a separate day or as a repeat, not more than three interpretations and three technical services from the list in GR 9.1.3 may be claimed.
The unscheduled service benefit (modifier SURC) may be claimed for the services outlined in GRs 15.9.1 through 15.9.3.
selected "V" category code services:
