Governing Rules:

• 3.1

  The following includes examples of, but is not limited to, services which are not a benefit under the Schedule and may not be claimed:

  1. Advice by telephone or other telecommunication methods except as specified under specific HSCs or for telehealth services;
  2. Ambulance services, except ambulance detention time HSCs 13.99K, 13.99KA, 13.99KB;
  3. Anesthetic materials;
  4. Any service a physician provides to his/her children, grandchildren, siblings, parents, grandparents, spouse or adult interdependent partner or any person who is dependent on the practitioner for support in accordance with the Alberta Health Care Insurance Regulation;
  5. Drugs/agents;
  6. Intravenous sedation for dental procedures administered to a patient who is not an inpatient or registered outpatient of a hospital;
  7. Medical appliances;
  8. Medical testimony in court, except psychiatric opinion at psychiatric review panel under the Mental Health Act;
  9. Secretarial or reporting fees;
  10. Stand-by time;
  11. Travel time of a practitioner to see a patient;
  12. Services requested or required by a third party. Examples include but are not limited to:
      • Examinations or certification related to adoption;
      • Medical examinations to indicate fitness to attend camp;
      • Autopsies;
      • Employment examinations and reports;
      • Examinations and reports requested under the auspices of the Child Welfare Act;
      • Immigration requirements;
      • Insurance/disability reports and forms;
      • Examinations and reports for judicial purposes (e.g., requested by police);
      • Medical-legal reports requested by patients or by lawyers on behalf of patients with the exception of HSC 03.01MT;
      • Motor vehicle license;
      • Examinations and forms relating to participation in sports;
      • Examinations and forms relating to university or other school requirements;
      • Passport and visa applications;
  13. Pre-travel assessments, counseling or administration of vaccines or drugs for travel purposes to reduce the patient's risk of acquiring an illness, or for prevention of communicable diseases not endemic to Canada;
  14. Administration of vaccines such as Hepatitis A and B is not covered unless specifically otherwise communicated by Alberta Health.
• 15.1

  In the case of physicians working exclusively in a hospital setting on either a full-time basis or as a part of their normal practice for a specified period of time (e.g. weekly hospital rotations among a practice group) off hours premium benefits may be claimed in accordance with the GRs for those claims as long as the claiming physician is the attending physician or is primarily responsible for the patient's care, or is claiming concurrent care in accordance with GR 4.8. In the case of physicians working in an AACC or UCC, off hours premium benefits may be claimed in accordance with the GRs for those claims as long as the claiming physician is the attending physician.

• 15.4

  In situations where the physician initiates the service, the unscheduled service or special callback benefits may not be claimed. Claims may however, be made for the after hours time unit premium benefit (modifier SURT) under 03.01AA. See GR 15.13.

• 15.13 AFTER HOURS TIME PREMIUM - HOSPITAL INPATIENT, OUTPATIENT AND EMERGENCY

  DEPARTMENTS, AACCs, UCCs, AUXILIARY HOSPITALS AND NURSING HOMES

• 15.13.1

  Benefits for the AFTER HOURS TIME PREMIUM (modifier SURT) are intended to provide physicians with compensation for services provided after hours during:

  • the evening on weekdays (1700 - 2200 hours),
  • the day and evening on weekends and statutory holidays (0700 - 2200 hours),
  • any night of the week (2200 - 0700 hours).
• 15.13.2

  The after hours time premium modifier applies to both scheduled and unscheduled services. In the case of unscheduled services, the unscheduled services modifier will also apply according to GRs 15.3 through 15.10.6.

• 15.13.4

  The after hours time premium modifier is to be claimed on a per 15 minute basis beginning at the time of contact with the patient and may only be claimed for direct patient care time related to the provision of an insured service. The after-hours time premium units may not be claimed for stand by time, e.g. time spent waiting for results of diagnostic tests.

• 15.13.5

  Time for the after hours time premium may be determined on a cumulative basis, and claimed according to the time period(s) in which the majority of the service occurred. HSC 03.01AA should be used to claim the after-hours time modifier for all services.

• 15.13.6

  In the event that one 15 minute period covers two time periods, the modifier claimed will be based on the time period where the majority of the 15 minute period occurred.

• 15.13.7

  In the event that the time spent with the patient covers more than one time period, additional modifiers may be claimed, each according to the time spent with the patient in that particular time period.

• 15.13.9

  The after hours time premium modifier may not be claimed for:

  • stand-by time;
  • non-invasive diagnostic procedures.
• 15.13.10

  The maximum number of after hours time premium modifiers per hour, per physician is 4.