In this Schedule "consultation" means that situation where a physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner after an appropriate examination of the patient, requests the opinion of a consultant physician, and the consultant does a history, an examination and a review of the diagnostic data and provides a written opinion with recommendations as to the treatment, to the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner. Consultations may not be claimed for the transfer of care alone.
Consultations may only be claimed when ALL of the following criteria have been met:
Consultations may NOT be claimed for transfer of care or pre operative assessments.
Consultations are billable up to and including the day of surgery.
The need for a consultation can arise as a result of the following:
Consultations may only be claimed when ALL of the following criteria have been met:
Consultations may NOT be claimed for transfer of care or pre operative assessments.
Consultations are billable up to and including the day of surgery.
A referral may be accepted from any person; however, to receive reimbursement as a consultation, a request must be made by the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner to the consultant in the form of:
Agent means any of the following individuals who are acting under the direction of the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner and the consultant, as appropriate:
Payment for a consultation to an Alberta physician may also be made when an Out of Province physician refers the patient and the criteria stated herein are met.
Consultations may only be claimed when ALL of the following criteria have been met:
Consultations may NOT be claimed for transfer of care or pre operative assessments.
Consultations are billable up to and including the day of surgery.
If a consultation is followed by a procedure performed by the consultant, a benefit may be claimed for the consultation as well as a major procedure up to and including the day of surgery.
Consultations may only be claimed when ALL of the following criteria have been met:
Consultations may NOT be claimed for transfer of care or pre operative assessments.
Consultations are billable up to and including the day of surgery.
A benefit for continuing care may be claimed by a consultant following a consultation where the continuing care is provided at the request of the referring physician, audiologist, chiropractor, midwife, podiatrist, dentist, optometrist, physical therapist or nurse practitioner.
Consultations may only be claimed when ALL of the following criteria have been met:
Consultations may NOT be claimed for transfer of care or pre operative assessments.
Consultations are billable up to and including the day of surgery.
Repeat consultations may not be claimed unless a further request has been initiated by and received from the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner for another consultation. A repeat consultation may not be claimed if initiated by the consultant.
Consultations may only be claimed when ALL of the following criteria have been met:
Consultations may NOT be claimed for transfer of care or pre operative assessments.
Consultations are billable up to and including the day of surgery.
When a physician sends a member of his family to another physician, a consultation benefit may not be claimed.
Consultations may only be claimed when ALL of the following criteria have been met:
Consultations may NOT be claimed for transfer of care or pre operative assessments.
Consultations are billable up to and including the day of surgery.
When a claim is submitted for the following HSCs, the referring practitioner field must be completed with a valid referring practitioner number.
HSCs in the following list marked with an asterisk(*) cannot be self-referred. Self-referred means the physician is providing the diagnostic service and treating the patient.
HSCs in Section E (Lab and Pathology) and X (Diagnostic Radiology) require a valid referring practitioner number with the following exceptions: HSC X27D does not require a referral and HSC X27F may be self-referred. HSC 03.03D requires a valid referring physician, chiropractor, midwife, podiatrist, dentist, optometrist, physical therapist or nurse practitioner number when it is a visit to a referred patient.
| 01.01A | 01.01B | 01.03 | 01.04A | 01.05A | 01.09 |
| 01.12A | 01.12B | 01.14 | 01.16A | 01.16B | 01.16C |
| 01.22 | 01.22A | 01.22B | 01.22C | 01.24A | 01.24B |
| 01.24BA | 01.24BB | 01.32 | 01.34 | 02.82A | 02.84A |
| 02.84B |
| 10.04 | 10.08A | 10.33B | 13.99CC 13.99GA* | 14.49A | |
| 14.82 | 14.85B | 14.88A | 14.88B | 15.94A | 16.83A |
| 16.83B | 16.83C | 16.89A | 16.92B | 17.81B | 19.81 |
| 22.81 | 24.89A | 24.89B | 28.8 A | 28.81A | 29.0 A |
| 30.81A | 33.22B | 37.81 | 37.82A | 37.82B | 38.89A |
| 38.89B | 39.21A | 39.62A | 39.83A |
| 40.92A | 41.29A | 41.29B | 42.09B | 43.81 | 43.82 |
| 44.3 B | 45.81A | 45.83 | 45.84B | 45.86A | 46.5 A |
| 46.81A | 46.82 | 46.84A | 46.88A | 48.92A | 48.98A |
| 48.98B | 49.93A | 49.95A | 49.96A | 49.96B | 49.98B |
| 49.98C | 49.98D |
| 60.82C | 60.89A | 62.12A | 62.12B | 62.81A | 63.86A |
| 63.96B | 64.95A | 64.97A | 66.19A | 66.3 C | 66.83 |
| 66.89A | 66.89B | 66.89C | 67.81 | 67.86 | 67.87A |
| 67.89A | 68.95 | 69.83A | 69.83B | 72.91 | 72.92A |
| 74.82A | 75.83A | 76.89A | 78.7 A | 79.29E |
| F7 |
Consultations may only be claimed when ALL of the following criteria have been met:
Consultations may NOT be claimed for transfer of care or pre operative assessments.
Consultations are billable up to and including the day of surgery.
