Billing for patients in a designated assisted living and assisted living facility

If the physician visits the patient in their individual living quarters within the designated assisted living (DAL) or assisted living (AL) facility, claims may be submitted using the home visit codes:

• 03.03N Home visit:
  • If there is only one person living in the individual living quarter, physicians would claim 03.03N.
  • Each individual living unit is considered a separate and distinct home. Therefore, each time a physician visits a patient in their living quarters, 03.03N should be claimed.
  • The location code should be HOME for this type of service.
  • The CMGP modifier can be added to the claim as appropriate.
• 03.03P Home visit, second/subsequent patients:
  • If there is more than one person living in the individual living unit, the claim for the second/subsequent patients seen in the unit should be submitted using 03.03P.
  • The location code should be HOME for this type of service.
  • The CMGP modifier can be added to the claim as appropriate.
  • If space is provided by the DAL or AL facility where a physician can see patients, the physician should claim an office visit (03.02A, 03.03A or 03.04A as appropriate to the service provided) with appropriate modifiers.
  • The location code on these types of claims would be OTHR unless the facility has a registered office space with Alberta Health.