Health Service Codes

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    Health Service Code 08.19L

    Issuance, development and documentation of a Community Treatment Order (CTO) as defined by the Mental Health Act including all activities and services that are directly related to the CTO initiation and development, per full 15 minutes

    NOTE:
    1. Services related to the development of the CTO include:
      1. Collecting and obtaining collateral information,
      2. Reviewing but not waiting for lab and other diagnostic information,
      3. Interviews with police, registered social workers, family, caregivers, facility staff etc.,
      4. Completion of related documents and forms,
      5. Communication with other health care providers and the physician receiving the patient in their respective community.
    2. May not be claimed for travel time or direct psychiatric treatment with the patient. Claims for direct psychiatric treatment should be submitted using the appropriate HSC.
    3. The total time spent developing the CTO may be calculated on a cumulative basis over the course of several hours or several days; however, the time spent developing the CTO must be recorded on a session by session basis in the patient's record. The claim for this HSC must be made when the CTO is complete and ready for implementation.
    4. May only be claimed by psychiatrists or physicians who are designated to perform this service by Alberta Health Services.
    5. May only be claimed once per patient per year.
    6. If a CTO has been cancelled and reissued within the year, supporting text is required for payment.
    7. Interviews mentioned above may be provided in person as well as by telephone or other telecommunication methods.
    Common terms:
    • CTO
    Category:V Visit
    Base rate:$49.37

    AMA billing tips:

    • 08.19L if a CTO was issued for the same patient within the previous 12 months, text must be added to the 08.19L claim to reissue the CTO as per note 6.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLGNMHReplace Base$49.37
    SKLLGPReplace Base$49.37
    SKLLPSYCReplace Base$61.52
    SESUSESU1 - 32For Each Call Pay Base At100%
    CALLM151 - 12For Each Call Pay Base At100%

    Governing Rules:

    • 2.3.1

      Unless otherwise specified, services that may be claimed once per year may be claimed 365 days after the previous service date or 366 days in a leap year.

    • 4.11.1

      A physician may submit claims for group psychotherapy, psychiatric management and/or indirect services for the same patient on the same day.

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