Fee Navigator®

    Health Service Code 03.08JZ

    Prolonged consultation or hospital admission by pediatrics (including subspecialties) and clinical immunology and allergy for patients 18 years of age and under, or by medical genetics (no age restriction), full 15 minutes or portion thereof for the first call when only one call is claimed - out of office.

    NOTE:

    May only be claimed:

    Common terms:
    • 18 years of age
    Category:V Visit
    Base rate:$61.36

    AMA billing tips:

      • Physicians that provide care in publicly funded sites are required to bill the "Z" codes.
      • Publicly funded facility types are: acute care centres, ambulatory care centres, auxiliary hospital, Health Canada Nursing Station, nursing home, regional contracted practitioner office (offices that are contracted by AHS to provide specific services) and subacute auxiliary hospital.
      • AHS and AH are conducting a review of physician overhead arrangements. Changes to the Z codes are expected to be implemented by October 1, 2020. In the meantime, there is still a requirement for physicians to claim the Z codes.
      • Please consult the Alberta Health Facility Directory for information regarding facility designations.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CALLM151 - 10For Each Call Pay Base At100%
    TELETELESYesIncrease Base To120%

    Governing Rules:

    • 1.33

      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

    • 4.1 COMPLETE EXAMINATION - DEFINITION:

      In the context of GR 4, complete physical examination shall include examination of each organ system of the body, except in psychiatry, dermatology and the surgical specialties. "Complete physical examination" shall encompass all those organ systems which customarily and usually are the standard complete examination prevailing within the practice of the respective specialty. What is customary and usual may be judged by peer review.

    • 4.3.3

      Time Based Consultations: Notwithstanding GRs 4.3.1 and 4.3.2, claims for consultation services as defined under HSCs 03.08F, 03.08I, 03.08IV, 03.08IZ, 03.08J, 03.08JV, 03.08JZ, 03.08L, 03.08M, 08.19A, 08.19AZ, 08.19AA, 08.19B, 08.19BB, 08.19C, 08.19CC, and 08.19CX may be claimed on a time basis.

    • 4.4.1

      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.