NOTE 1. May only be claimed in addition to HSC 13.59V when the physician spends greater than 10 minutes directly with the patient. Does not include time spent on indirect patient care such as charting.
Category: | V Visit |
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Base rate: | $20.00 |
13.59VA may be claimed in the case where the patient has an immediate post-vaccination reaction, or the physician is required to counsel patient at the time of vaccination regarding vaccine hesitancy, questions, etc., AND the physician spends more than 10 minutes with the patient, claim 13.59VA, in addition to 13.59V. The patient’s record must describe counselling provided, any adverse reactions to the vaccine, as well as start and stop time of the physician’s direct service to the patient.
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:
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).
No modifiers.
Daily patient volume payment rules will apply to visit services with a "V" category code (excluding HSC 03.01AD, 03.01N, 03.03CV, 03.03FV, 03.05LB, 03.08CV, 08.19CV, 08.19CW, 08.19CX, 08.44A, 08.44B, 08.44C, 08.44D, 13.59V, 13.59VA, 13.82A, 13.99AC, 13.99O and 13.99OA) that are provided in an office, home, or a non-registered facility.
Excluding Grande Prairie and Fort McMurray, the daily patient volume payment rules will not apply to services provided in communities that are eligible for variable fee payments under the Rural Remote Northern Program.
The total of all billings for eligible category "V" codes that are accepted for payment under the Alberta Health Care Insurance Plan will be calculated for each practitioner for each calendar day. When the daily total exceeds 50, the practitioner's payment on the category "V" codes that exceed 50 will be discounted by 50 percent. When the daily total exceeds 65, the practitioner's payment on the category "V" codes that exceed 65 will be discounted by 100 percent.
Services will be assessed and payment/discounts will be applied to services in the order in which they are accepted for payment by the Alberta Health Care Insurance Plan.
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