Fee Navigator®

    Health Service Code 13.99OA

    Management of patient on hemodialysis or peritoneal dialysis (per week)

    NOTE:
    1. May only be claimed by nephrologists.
    2. May not be claimed in addition to HSC 13.99B or 13.99D within the same calendar week.
    3. May be claimed once per patient within the same calendar week if not preceded by any visit except those outlined in Note 4.
    4. HSCs 03.03AR, 03.03DF and special callback benefits (HSCs 03.03KA, 03.03LA, 03.03MC, 03.03MD, 03.05N, 03.05P, 03.05QA, 03.05QB, 03.05R) may be claimed within the same calendar week for the same patient by the same physician.
    5. Other HSCs (03.08A, 03.08AZ, 03.07B, 03.04A, 03.04AZ, 03.03A, 03.03AZ, 03.03F, 03.03FZ) may not be claimed in the same calendar week for the same patient by any nephrologist. Exceptions to this include consultation and visit HSCs that are related to assessment for kidney/kidney-pancreas transplantation, which may be claimed within the same calendar week by nephrologists with special interest or training in transplantation. For the exceptions, supporting text must be submitted.
    6. The physician must be actively involved in the management of the patient's care in order to claim.
    Category:V Visit
    Base rate:$131.51

    Fee modifiers:

    No modifiers.

    Governing Rules:

    • 19.1

      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.