| Category: | V Visit |
|---|---|
| Base rate: | $42.50 |
| Type | Code | # of calls | Explicit | Action | Amount |
|---|---|---|---|---|---|
| LEVL | CARDH1 | Replace Base | $104.20 | ||
| LEVL | CARDH2 | Replace Base | $104.20 | ||
| LEVL | CLIMH1 | Replace Base | $56.82 | ||
| LEVL | CLIMH2 | Replace Base | $56.82 | ||
| LEVL | CRCMH1 | Replace Base | $45.67 | ||
| LEVL | CRCMH2 | Replace Base | $45.67 | ||
| LEVL | DERMH1 | Replace Base | $52.71 | ||
| LEVL | DERMH2 | Replace Base | $52.71 | ||
| LEVL | E/M H1 | Replace Base | $78.05 | ||
| LEVL | E/M H2 | Replace Base | $78.05 | ||
| LEVL | GASTH1 | Replace Base | $68.00 | ||
| LEVL | GASTH2 | Replace Base | $68.00 | ||
| LEVL | GNSGH1 | Replace Base | $42.50 | ||
| LEVL | GNSGH2 | Replace Base | $30.67 | ||
| LEVL | HD1 | Replace Base | $46.08 | ||
| LEVL | HD2 | Replace Base | $33.25 | ||
| LEVL | HEMH1 | Replace Base | $56.82 | ||
| LEVL | HEMH2 | Replace Base | $56.82 | ||
| LEVL | IDISH1 | Replace Base | $57.00 | ||
| LEVL | IDISH2 | Replace Base | $57.00 | ||
| LEVL | INMDH1 | Replace Base | $56.82 | ||
| LEVL | INMDH2 | Replace Base | $56.82 | ||
| LEVL | MDGNH1 | Replace Base | $61.36 | ||
| LEVL | MDGNH2 | Replace Base | $61.36 | ||
| LEVL | MDONH1 | Replace Base | $56.82 | ||
| LEVL | MDONH2 | Replace Base | $56.82 | ||
| LEVL | NEPHH1 | Replace Base | $87.88 | ||
| LEVL | NEPHH2 | Replace Base | $87.88 | ||
| LEVL | NEURH1 | Replace Base | $59.36 | ||
| LEVL | NEURH2 | Replace Base | $59.36 | ||
| LEVL | NPMH1 | Replace Base | $61.36 | ||
| LEVL | NPMH2 | Replace Base | $61.36 | ||
| LEVL | PDGEH1 | Replace Base | $68.00 | ||
| LEVL | PDGEH2 | Replace Base | $68.00 | ||
| LEVL | PEDCH1 | Replace Base | $104.20 | ||
| LEVL | PEDCH2 | Replace Base | $104.20 | ||
| LEVL | PEDH1 | Replace Base | $61.36 | ||
| LEVL | PEDH2 | Replace Base | $61.36 | ||
| LEVL | PEDNH1 | Replace Base | $87.88 | ||
| LEVL | PEDNH2 | Replace Base | $87.88 | ||
| LEVL | PHMDH1 | Replace Base | $51.12 | ||
| LEVL | PHMDH2 | Replace Base | $51.12 | ||
| LEVL | RHEUH1 | Replace Base | $51.69 | ||
| LEVL | RHEUH2 | Replace Base | $51.69 | ||
| LEVL | RSMDH1 | Replace Base | $52.30 | ||
| LEVL | RSMDH2 | Replace Base | $52.30 | ||
| CARE | COINPT | Yes | Increase Base By | $40.51 | |
| LMTS | TOC | Yes | Increase Base By |
For administrative purposes the start of the day is considered to be midnight. A hospital visit which takes place after 0700 hours may be claimed in addition to one of the following services provided between midnight and 0700 hours:
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 |
| 03.01O* | 03.01LJ* 03.01LK* 03.01LL* *03.03D | 03.03F* | ||
| 03.03FA* | 03.03FT* 03.03FV* 03.03FZ* 03.04Q* | 03.05B* | ||
| 03.07A* | 03.07AZ* 03.07B* | 03.07C* | 03.08A* | 03.08AZ* |
| 03.08B* | 03.08BZ* 03.08C* | 03.08CV* 03.08F* | 03.08H* | |
| 03.08K* | 03.08L* | 03.08M* |
| 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 |
If the services of more than one physician are required because of the complexity of the clinical needs of a patient, each physician may claim a benefit for concurrent care. Satisfactory supporting information must accompany the claim.
If a consultation is required, the attending physician and the consultant may each claim for services provided on the day of consultation.
If the provisions of GR 4.4.5 apply, a benefit may be claimed by the referring physician only after the full responsibility for the care of the patient has been returned to him/her, or the complexity of the clinical needs of the patient require the services of the referring physician in addition to those of the consultant.
If medical complications develop or are present which require active management by the family physician, hospital visits should be claimed in accordance with GR 4.8.
If the care of a patient is transferred, each physician may claim for services provided on the day of transfer.
If a physician transfers the care of a hospitalized patient to a second physician, the second physician may claim daily care. The applicable benefit rate will be determined by the number of days of the patient's hospitalization except as provided in GR 4.10.3.
When the care of a patient is transferred to a second physician, the second physician may charge daily hospital care, starting at the rate allowed for the first to seventh day, only if the transfer was due to the onset of a significant new illness.
If a patient is transferred to another hospital under the care of another physician, hospital visit services shall be claimed as though this were a first admission.
A physician who admits a patient to hospital and provides pre-operative care but does not perform the surgery, may claim benefits for the services up to and including the day of surgery.
The benefit for care of a healthy newborn in hospital does not apply when the infant is ill. In these circumstances, the daily hospital visit HSCs apply.
If newborn and premature care is provided by a pediatrician,
The benefit for care of a healthy newborn in hospital does not apply when the infant is ill. In these circumstances, the daily hospital visit HSCs apply.
If a patient is admitted to a hospital for the purpose of undergoing a procedure designated "+", a benefit is payable for a visit provided the day before or the day after the procedure is performed, but if the procedure is performed and a visit occurs on the same day, a benefit is payable for either the procedure or the visit, but not both.
Prenatal visits (HSC 03.03B), emergency, outpatient and inpatient hospital visits may be claimed up to the time of delivery, including the day of delivery; except in the situation where delivery occurs within 24 hours of admission, in which case neither a hospital admission (03.04C) nor a hospital visit (03.03D) may be claimed.
When a delivery occurs within 24 hours of admission, the delivery benefit includes the hospital admission (HSC 03.04C) or hospital visit (03.03D). Post-partum hospital visits, by the same or different physician, for the period of one week after the delivery, and ordinary immediate care of the newborn are also included. When there is a life threatening situation which requires neonatal resuscitation, HSC 13.99F may be claimed as well.
Post-operative services shall be claimed under the appropriate hospital visit HSC 03.03D.
