Fee Navigator

    Modifier: CARE

    COMPLEX PATIENT CARE

    Used to indicate complex patient care.

    Codes:

    Code:Description:
    CMXC30
    COMPLEX PATIENT CONSULTATION/VISIT
    Explicit

    This modifier is used to indicate a complex patient consultation or visit requiring that the physician spend 30 minutes or more on management of the patient's care.

    1. May only be claimed for HSCs 03.04A, 03.04B, 03.04C, 03.04D, 03.04E, 03.04F, 03.04FA, 03.04G, 03.04GA, 03.04H, 03.04HA, 03.04M, 03.08A, 03.08B, 03.08C, 03.08F, 03.08H, 03.08K and 03.09A.
    2. May be claimed with HSC 03.08A when claiming prolonged consultations, ie. HSCs 03.08I, 03.08J, 03.08L, 03.08M.
    CMXV15
    COMPLEX PATIENT CONSULTATION/VISIT
    Explicit

    This modifier is used to indicate a complex patient consultation or visit requiring that the physician spend 15 minutes or more on management of the patient's care. Refer to modifier CMXV30 for visits taking 30 minutes or more. May only be claimed by:

    • community medicine, geriatric medicine, occupational medicine, radiation oncology for HSCs 03.03A, 03.07A, 03.07B.
    • cardiology, endocrinology/metabolism, hematology, infectious diseases, internal medicine, medical oncology, nephrology, pediatric cardiology, pediatrics, rheumatology for HSCs 03.03A, 03.03F, 03.07A, 03.07B. Pediatrics may claim for HSC 03.05JK.
    CMXV20
    COMPLEX PATIENT CONSULTATION/VISIT
    Explicit

    This modifier is used to indicate a complex patient consultation or visit requiring that the physician spend 20 minutes or more on management of the patient's care. Refer to modifier CMXV35 for visits taking 35 minutes or more. May be claimed by groups other than those eligible for the CMXV15, CMXV30 modifiers for HSCs 03.03A, 03.03B, 03.03C, 03.03F, 03.07A, 03.07B, 03.07C as appropriate to the physician's specialty. This modifier may also be claimed by any physician for HSCs 03.05CR, 03.05DR, 03.05ER, 03.05F, 03.05FA, 03.05FB, 03.05FC, 03.05FD, 03.05FE, 03.05FF, 03.05FG, 03.05FH, 03.05FR, 03.05GR, 03.05HR when location and time conditions (above) are met.

    CMXV30
    COMPLEX PATIENT CONSULTATION/VISIT
    Explicit

    This modifier is used to indicate a complex patient consultation or visit requiring that the physician spend 30 minutes or more on management of the patient's care. Refer to modifier CMXV15 for visits less than 30 minutes. May only be claimed by:

    • community medicine, geriatric medicine, occupational medicine, radiation oncology for HSCs 03.03A, 03.07A, 03.07B.
    • cardiology, endocrinology/metabolism, hematology, infectious diseases, internal medicine, medical oncology, nephrology, pediatric cardiology, pediatrics, rheumatology for HSCs 03.03A, 03.03F, 03.07A, 03.07B. Pediatrics may claim for HSC 03.05JK.
    • general practice for HSC 03.05H only.
    CMXV35
    COMPLEX PATIENT CONSULTATION/VISIT
    Explicit

    This modifier is used to indicate a complex patient consultation or visit requiring that the physician spend 35 minutes or more on management of the patient's care. Refer to modifier CMXV20 for visits taking less than 35 minutes. May be claimed by groups other than those eligible for the CMXV15, CMXV30 modifiers for HSCs 03.03A, 03.03B, 03.03C, 03.03F, 03.07A, 03.07B, 03.07C as appropriate to the physician's specialty. This modifier may also be claimed by any physician for HSCs 03.05CR, 03.05DR, 03.05ER, 03.05F, 03.05FA, 03.05FB, 03.05FC, 03.05FD, 03.05FE, 03.05FF, 03.05FG, 03.05FH, 03.05FR, 03.05GR, 03.05HR when location and time conditions (above) are met.

    COINPT
    COMPLEX INPATIENT CARE
    Explicit

    This modifier is used to indicate management of a complex hospital inpatient, or a long term care (LTC) patient for palliative care or intercurrent illness when the conditions to claim HSCs 03.03D or 03.03AR are met.

    1. May only be claimed once per patient, per physician, per day.
    2. May only be claimed for the management of complex hospital inpatients with multi-system disease:
      • whose co-morbidities contribute to complicating or increasing the care required by the claiming physicians involved in the care of the patient; and
      • whose care requires that the physician spend 20 minutes or more per day on management of the patient's ongoing care.
    3. May not be claimed for transfer of care where the receiving physician requires time to familiarize him/herself with the patient unless the conditions outlined in (2) above are met.