| Category: | V Visit |
|---|---|
| Base rate: | $53.13 |
| Type | Code | # of calls | Explicit | Action | Amount |
|---|---|---|---|---|---|
| CALL | M15 | 1 - 12 | For Each Call Pay Base At | 100% | |
| SURC | EV | Yes | Increase By | $48.82 | |
| SURC | NTAM | Yes | Increase By | $117.12 | |
| SURC | NTPM | Yes | Increase By | $117.12 | |
| SURC | WK | Yes | Increase By | $48.82 | |
| TELE | TELES | Yes | Increase Base To | 120% |
Limited Consultation: Limited assessment of a patient and a written report to the referring physician, audiologist, Alberta registered midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner. A limited consultation includes a history limited to and related to the presenting problem, and an examination which is limited to relevant body systems, an appropriate record, and advice to the patient. It may include the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient and/or the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner.
Psychiatric Consultation referred by other professions: A benefit for a psychiatric consultation (HSCs 08.19AA, 08.19BB, 08.19CC) may be claimed when a patient is referred to a psychiatrist by a registered: occupational therapist, psychologist, community based psychiatric nurse, social worker or speech language pathologist and the provisions that apply to consultations under GRs 4.3, 4.4 and 4.6 are met.
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 |
The unscheduled service benefit (modifier SURC) may be claimed for the services outlined in GRs 15.9.1 through 15.9.3.
selected "V" category code services:
