Comprehensive visits and/or comprehensive/major consultations may only be claimed once every 365 days per patient by the same physician. Comprehensive visit and consultation services are defined as HSCs 03.04A, 03.04AZ, 03.08A, 03.08AZ, 03.08B, 03.08BZ, 03.08C, 03.08CV, 03.08F, 03.08H, 03.08K, 08.11A, 08.11C, 08.19A, 08.19AZ, 08.19AA, and 08.19CX.
HSC 03.09B is defined as comprehensive and may not be billed more frequently than once every 180 days by the same physician.
HSCs 03.04O and 03.04P are defined as comprehensive services and may not be billed more frequently than four times per year as indicated or within 180 days of a comprehensive service or consultation by the same physician.
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.
For clarity, if the patient had a comprehensive May 16th, 2018, the next comprehensive by the same physician is not technically eligible until May 16th of 2019.
Alberta Health has relaxed the system rules to 345 days, be advised that this adjustment to the payment processing rules is intended to accommodate a small variance in patient/physician schedules; and not as permission to bill a comprehensive more frequently.
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.
Notwithstanding GR 4.6.1, an initial prenatal examination 03.04B may not be claimed within 90 days of another comprehensive visit or consultation. Comprehensive visit and consultation services are defined under GR 4.6.1. There must be an interval of 90 days between the first and second services.
