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

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.
Follow up treatment may be claimed in 12 week intervals.
Only one call may be claimed regardless of the number of injections performed.
May be claimed in addition to a visit or a consultation.

Patients may be charged for the Botox 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.
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.
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Type	Code	# of calls	Explicit	Action	Amount
BMI	BMIANE		Yes	Increase By	25%
BMI	BMIANT		Yes	Increase By	25%
ROLE	ANE		Yes	Replace Base	$112.39
ROLE	ANEST		Yes	Replace Base	$18.70
ANU	ANU	1		For Each Call Pay Base At	100%
ANU	ANU	2 - 150		For Each Call Increase By	$18.70
UGA	UGA		Yes	Replace Base	$134.85
TRAY	MINT			Increase By	$13.14
NBTR	NBTR		Yes
LVP	LVP75		Yes	Reduce Base To	75%

6.8.4

Where a procedure is performed under general anesthesia, the following applies:

If the procedure is the only procedure performed at that time, a benefit of $134.85 may be claimed.
If another procedure is also performed at the same encounter and the listed benefit payable in respect of it under the Schedule is greater than $134.85 the physician is entitled to receive that listed benefit plus a percentage of the listed benefit for the lesser procedure(s) calculated in accordance with this Schedule. The $134.85 minimum benefit does not apply to the lesser procedures.
If multiple procedures are performed at the same encounter and the listed benefit payable in respect of each of them under the Schedule is less than $134.85, the physician is entitled to receive a benefit of $134.85 in respect of the greater procedure plus a benefit in respect of each of the lesser procedures that is a percentage of the listed benefit and calculated in accordance with this schedule. The $134.85 minimum benefit does not apply to the lesser procedures.
If multiple procedures are performed at the same encounter and only one of them appears under GR 6.8.4 (e), the physician is entitled to receive a benefit of $134.85 in respect of that procedure plus a benefit in respect of the other procedures that is a percentage of the listed benefit and calculated in accordance with this schedule.

GR 6.8.4 applies to the following HSCs:

50.4 A	50.94D	50.94E	50.94F	50.97A	51.43
51.53A	52.1 A	53.81B	53.83A	54.92D	58.99F

70.1	70.2 A	70.2 B	70.2 H	70.4 F
70.5 A	72.91	74.82A	76.91A	78.7 A	79.29E