Virtual Care Code Changes – Recognition of Patient Management Time

January 18, 2022

To support the appropriate uptake and integration of virtual care in the province, patient management that is related to the provision of an insured service may be included in the time calculations for certain virtual services. This means the physician time spent reviewing patient charts, completing referrals, etc. may count toward the time requirements for Health Service Codes (HSC) 03.01AD, 03.03CV, 03.03FV, and 03.08CV. To be eligible to claim for patient management time, all services must be completed by the physician on the same date as the patient’s virtual visit. Virtual visits still require that the physician have direct contact with the patient, the patient’s guardian or agent (as defined by the Personal Directive Act). Only physician time can be claimed.

Claims for virtual care with the appropriate modifier may be submitted after AH has notified physicians through an updated Bulletin. If holding back claims for these services is not an option for you, please read the claims submission information at the end of this Billing Tip.

Fee Code

Modifier

Eligible Specialties
03.03CV CMGP01
  • Family Medicine - (skill code GP) limited at this time to one unit, CMPGP01. May only be claimed when the same-day total physician time spent providing patient care is at least 15 minutes.
  CMXV15
  • Community medicine, geriatric medicine, occupational medicine, radiation oncology, cardiology, endocrinology/metabolism, hematology, infectious diseases, internal medicine, medical oncology, nephrology, pediatric cardiology, pediatrics and rheumatology when the same-day total physician time spent providing patient care is at least 15 minutes.
  CMXV20
  • All other specialties not listed in CMXV15 or CMGP when the same-day total physician time spent providing patient care is at least 20 minutes.
03.03FV CMXV15
  • Cardiology, endocrinology/metabolism, hematology, infectious diseases, internal medicine, medical oncology, nephrology, pediatric cardiology, pediatrics, pediatric nephrology, rheumatology when the same-day total physician time spent providing patient care is at least 15 minutes.
  CMXV20
  • Clinical immunology, critical care medicine, gastroenterology, medical genetics, neurology, neonatal perinatal medicine, pediatric neurology, pediatric gastroenterology, physical medicine, respiratory medicine, urology, vascular surgery when the same-day total physician time spent providing patient care is at least 20 minutes.
03.08CV CMXC30
  • All specialties when the same-day total physician time spent providing patient care is at least 30 minutes.

Claim Submission Information

Alberta Health has not announced the go-live date for submission of virtual care claims with a modifier.

In the meantime, physicians may either; 1) hold their claims for these services or 2) submit a claim for the virtual visit without modifier and change (Action Code C) the claim to include the modifier when the Alberta Health system is ready to accept virtual claims with a modifier. Option 2 requires more administrative attention but offers the option to receive some compensation in a shorter time frame. Here are the steps for option 2:

  1. Submit the claim to Alberta Health without the modifier
  2. Following Alberta Health’s advice that claims for virtual codes with modifiers may be submitted: 
    • retrieve the original claim (assuming the claim paid as submitted without any explanatory codes on the Statement of Assessment from AH);
    • add the appropriate modifier to the claim;
    • resubmit the claim using action code “C”;
    • You should receive payment for the modifier portion of the claim only on the next Statement of Assessment from Alberta Health.

Reminders:

  • DO NOT add text to the claim, 
  • Be sure to use action code “C” as it signals that there is a change to the claim. The payment system will then process ONLY the changes. The next statement of assessment from AH will include a payment for the modifier portion of the claim only.
  • DO NOT generate a new claim number; be sure that you are using the original valid claim number. If you use a new claim number or generate a new claim, AH’s payment system will deem the second claim to be a duplicate claim and the claim will reject.

For more information about claims submission processes, please refer to section 3.0 Claims Submission of the Physicians Resource Guide.

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