Fee Navigator®

    Health Service Code 13.59V

    Immunization and administration of COVID-19 vaccine

    1. May only be claimed if the initial purpose of the visit is to administer the COVID-19 vaccine. May not be claimed on the same day as a visit service (except 13.59VA). If the COVID-19 vaccine is administered as part of a scheduled visit or any other service that was unrelated to the vaccine, the physician may bill the appropriate service and 13.59A with diagnostic code 079.82 or 079.8.
    2. Benefit includes: a. Determination of appropriate candidacy of the patient for the vaccination. This includes but not limited to reviewing patient records in Alberta Netcare or another appropriate patient record system to ensure that vaccine dose being provided is appropriately sequenced. b. General discussion with the patient, parent, guardian and or agent as defined by the Personal Directives Act regarding the benefits and risks associated with the vaccine. c. Obtaining consent. d. Administration of a single dose of the vaccine. e. Monitoring the patient for any immediate post-vaccination adverse effects. f. Updating the patient's immunization record on the Immunization Direct Submission Mechanism. g. Appropriate record and scheduling the second/subsequent vaccine date as appropriate in the patient's record and reasonably follow-up with the patient to ensure the second dose is administered.
    3. May be claimed by the physician when provided by a nurse or other qualified health provider under direct physician supervision or when the physician is on site and immediately available.
    4. The patient's record must provide a detailed description of the service and must include the vaccine administered and the name of the provider who administered the vaccine.
    Category:V Visit
    Base rate:$25.00

    AMA billing tips:

    • 13.59V may be claimed in a physicians office when they are supervising qualified staff to provide the injection or when they provide the injection themselves. 13.59V is NOT billable in an AHS mass vaccination clinic where the physician is supervising multiple staff. In this instance, physicians may ONLY bill for the vaccinations that they provide themselves. Physicians must be sure to record the vaccination they have provided or have supervised in the Immunization Direct Submission Mechanism as there are fines starting at $100,000 for the first offence for failure to record the vaccination.

    • Claims for non-entitled residents (PQ, out of province, non registered Alberta residents or out of country) may be submitted for 13.59A or 13.59VA, should be submitted as follows:

      • The ULI field should always be blank.
      • The person data fields must be completed in full.
      • The OOP registration number should be in the appropriate field with a corresponding ‘recovery code’.
      • OOP resident claims for covid injections should be submitted as medical reciprocal but text is required to hold the claim for manual review. If there is no text, the system will automatically reject the claims as medically excluded.
      • Some EMR systems will not allow a submitter to submit with both the ULI and registration number fields blank (for non-residents / PQ). In this case, enter 9 zeros in the registration number field with a corresponding recovery code of SK and the appropriate text (even though they may not be a SK resident). This has been tested and will work BUT it is essential that the text and personal data be included as it is used to then modify the claim correctly upon receipt.

      To be clear, as per Gen 126, text is required on all claims for non-entitled residents (PQ, out of province, non registered Alberta residents or out of country). Text is to include all insurance eligibility (whether that is an out of country insurance company name and number that the physician obtained from the patient, an AHS assigned ULI OR if using all zero’s in the registration field, the patient’s OOP registration number).

    Fee modifiers:

    No modifiers.

    Governing Rules:

    No Governing Rules.