NOTE: 1. Benefit includes the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient. 2. May not be claimed in addition to HSC 03.05JB at the same encounter.

NOTE: 1. Benefit includes the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient. 2. May not be claimed in addition to HSC 03.05JB at the same encounter.

NOTE: 1. At a minimum a physician must complete a limited assessment of a patient's condition requiring a history related to the presenting problems, appropriate records, and advice to the patient. The total physician time spent providing patient care activities must last a minimum of 10 minutes. If the total physician time spent on the same day is less than 10 minutes, the service must be claimed using HSC 03.01AD. 2. May only be claimed if the service was initiated by the patient or their agent (agent as defined in the Personal Directives Act). 3. May only be claimed if the service is personally rendered by the physician. 4. Benefit includes the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient. 5. The patient's record must include a detailed summary of all services provided including time spent and start and stop times. 6. Time spent on administrative tasks cannot be claimed. 7. May not be claimed on the same day as HSC 03.01AD, 03.01S, 03.01T, 03.03FV, 03.05JR, 03.08CV, 08.19CV, 08.19CW, or 08.19CX by the same physician for the same patient. 8. May not be claimed on the same day as an in-person visit or consultation service by the same physician for the same patient.

NOTE: May be claimed once per patient per physician per pregnancy.

NOTE: 1. Specialist rates are for referred hospital visits only. 2. A maximum of six level one days may be claimed when the same physician claims a comprehensive visit or consultation on the date of hospital admission. 3. Only one HSC 03.03D may be claimed per patient, per physician, per day. Special callbacks (HSCs 03.05N, 03.05P, 03.05QA, 03.05QB, 03.05R) may be claimed when the criteria listed under HSC 03.05R are met. 4. Modifier COINPT may be claimed for the management of complex acute care hospital inpatients with multi-system disease. Refer to the COINPT modifier definition for clarification regarding the use of this modifier.

NOTE: 1. May be claimed when HSC 03.03D has been claimed at a different encounter by the same or different physician. 2. May be claimed in addition to a special callback (HSC 03.03KA, 03.03LA, 03.03MC, 03.03MD) only where HSC 03.03D has been claimed for palliative or acute inter-current illness in an auxiliary hospital or nursing home. 3. Claims for second and subsequent patients seen on a priority basis after initial callback (HSC 03.05N, 03.05P, 03.05QA, 03.05QB, 03.05R) must be made using HSC 03.03AR, if HSC 03.03D has already been claimed at a different encounter by the same or different physician.

NOTE: 1. May only be claimed for visits where the patient is complex and requires a minimum of 15 minutes on patient care management. 2. May not be claimed on the same date of service as any visit service by the same physician. 3. Time may be claimed on a cumulative basis. 4. May only be claimed by pediatricians and pediatric subspecialties.

NOTE: 1. May only be claimed by endocrinology/metabolism, general internal medicine, gastroenterology, infectious disease, general surgery, cardiology, hematology, clinical immunology medical oncology, nephrology, pediatrics, pediatric subspecialities and respiratory medicine. 2. May be claimed on the date of transfer by the receiving physician when assuming responsibility for care of a hospital in-patient. 3. Only one transfer may be claimed per patient, per calendar week, regardless of whether the same or different physician provides the service. 4. The physician from whom the care is being transferred may claim a hospital visit or intensive care visit on the day of transfer. 5. May not be claimed for weekend coverage or within 24 hours of admission to hospital. 6. May not be claimed during post-operative time periods unless complications occur.

NOTE: 1. May only be claimed by general surgery, orthopedics and urology. 2. May only be claimed when a consultation for the patient has already been claimed by another physician of the same specialty. 3. May be claimed in addition to a procedure on the same date of service.

NOTE: 1. May only be claimed by internal medicine at the time the patient is seen. 2. May be claimed on the date of transfer by the receiving physician when admitting the patient. 3. May not be claimed in addition to any other visit or consultation on the same date of service by the same physician. 4. Callbacks and HSC 03.03DF at a separate encounter for the same date of service by the same or different physician may be claimed in addition.

NOTE: 1. May only be claimed by the patient's physician of record, or by physicians working as part of an on-call rotation. 2. May not be claimed by physician extenders. 3. May only be claimed for direct attendance with the patient.

NOTE: 1. May be claimed once per calendar week if no other visit precedes in the same calendar week for the same patient by the same physician. 2. HSC 03.03EA and special callbacks (HSCs 03.03AR, 03.03KA, 03.03LA, 03.03MC, 03.03MD) may be claimed subsequent to a 03.03E in the same calendar week for the same patient by the same physician. 3. HSC 03.03D may be claimed for palliative care or inter-current illness.

NOTE: 1. May only be claimed in addition to HSC 03.03F or 03.03FZ when the 03.03F or 03.03FZ exceeds 30 minutes. 2. May only be claimed by pediatrics (including subspecialties) and clinical immunology and allergy for patients 18 years of age and under, or by cardiology, endocrinology/metabolism, gastroenterology, infectious diseases, internal medicine, hematology, medical genetics, medical oncology, neurology, physiatry, respiratory medicine, rheumatology, urology and vascular surgery (no age restriction).

NOTE: 1. May only be claimed in addition to HSC 03.03FV when the service exceeds 30 minutes. 2. May only be claimed by pediatrics (including subspecialties) and clinical immunology and allergy for patients 18 years of age and under, or by cardiology, endocrinology/metabolism, gastroenterology, infectious diseases, internal medicine, hematology, medical genetics, medical oncology, neurology, physiatry, respiratory medicine, rheumatology, urology and vascular surgery (no age restriction). 3. The patient's record must include a detailed summary of all services provided including time spent and start and stop times. 4. Time spent on administrative tasks cannot be claimed. 5. May not be claimed on the same day as an in-person visit or consultation service by the same physician for the same patient.

NOTE: Supervising a respiratory problem as an example Anesthetist specialty restriction.

NOTE: Refer to the notes following HSC 03.03MD.

NOTE: Refer to the notes following HSC 03.03MD.

NOTE: Refer to the notes following HSC 03.03MD.

NOTE: 1. For hospital emergency/outpatient department, AACC, UCC refer to GR 15.3. 2. For auxiliary hospital and nursing home visits, refer to the following notes: - Benefits for HSCs 03.03KA, 03.03LA, 03.03MC, 03.03MD may only be claimed when the physician is requested to attend a patient, by the patient, the patient's relatives or a health care provider of the facility involved in managing the patients care. - HSC 03.03EA may be claimed in addition to a special callback to an auxiliary hospital or nursing home. - HSC 03.03D may be claimed for palliative care or acute inter-current illness. - HSC 03.03DF may only be claimed where HSC 03.03D has been claimed for palliative care or acute inter-current illness in an auxiliary hospital or nursing home. Special callback benefits (03.03KA, 03.03LA, 03.03MC, 03.03MD) may be claimed in addition. - Benefits for HSCs 03.03KA, 03.03LA, 03.03MC, 03.03MD are payable based on the time at which the encounter commences. - The physician responds to such a call from outside the auxiliary hospital or nursing home, on an unscheduled basis. - The patient is attended on a priority basis. - Special callback benefits (HSCs 03.05N, 03.05P, 03.05QA, 03.05QB, 03.05R) may not be claimed in addition.

NOTE: 1. When a physician must travel to his/her office which is closed, with no staff in attendance. 2. A maximum of five (5) per weekday, per physician may be claimed. 3. Subsequent patients seen may be claimed under code 03.02A, 03.03A, 03.04A or the appropriate procedural code.

NOTE: 1. When a physician must travel to his/her office which is closed, with no staff in attendance. 2. A maximum of ten (10) per weekend day or statutory holiday, per physician may be claimed. 3. Subsequent patients seen may be claimed under code 03.02A, 03.03A, 03.04A or the appropriate procedural code.