Fee Navigator®

    Health Service Code 13.59O

    Injections of Botulinum A Toxin for the prophylaxis of chronic migraine headaches for eligible patients 18-65 years of age

    1. Eligible patients will have suffered headache activity for greater than 15 days per month with each episode lasting four or more hours for three consecutive months prior to the initial treatment.
    2. Follow up treatment may be claimed in 12 week intervals.
    3. Only one call may be claimed regardless of the number of injections performed.
    4. May be claimed in addition to a visit or a consultation.
    Common terms:
    • Botox
    Category:M Minor Procedure
    Base rate:$100.91

    AMA billing tips:

    • 13.59O is an inclusive fee and includes payments for all elements of the service except for the Botulinum A Toxin. Physicians cannot charge a fee of any kind over and above the listed rate. If the service is delegated to a qualified staff member, it is still considered to be insured under the AHCIP but payable at $0 as it cannot be delegated (MED 97). The physician must not submit a claim to AHCIP or charge the patient for the service. Physicians who provide the drug for the service may charge the patient for the Botulinum A Toxin following the College of Physicians & Surgeons of Alberta Standards of Practice (Standard 13) Dispensing of Schedule 1 or 2 drugs by a physician for a fee. Patients may not be charged for any other fees related to the provision of the service.

      The Botox injections for migraines may be claimed in addition to a visit or consultation as appropriate. However, the time spent performing the injections may not be included in the time claimed for complex modifiers or prolonged visits/consultations.

      For more information on the management of headaches, please visit the Toward Optimized Practice website.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    ROLEANEYesReplace Base$112.39
    ROLEANESTYesReplace Base$18.70
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.70
    UGAUGAYesReplace Base$134.85
    TRAYMINTIncrease By$13.14
    LVPLVP75YesReduce Base To75%

    Governing Rules: