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To: All Physicians and Billing Staff

Effective March 31, 2020, a set of new Health Service Codes (HSCs) will be required to submit claims for

certain services performed in the following publicly funded facilities (out-of-office):

Active Treatment Centres (ACT) (e.g. hospitals)

Ambulatory Care Centres (AMCC)

Community Ambulatory Care Centres (CACC) including:

‒ Urgent Care Centres (UCC); and Advanced Ambulatory Care Centres (AACC)

Auxiliary Hospitals (AUX)

Health Canada Nursing Stations (HCNS)

Community Mental Health Clinics (MLHL)

Nursing Homes (NH)

Regional Contracted Practitioner Offices (RCPO)

Subacute Auxiliary Hospitals (SUBA)

What is changing?

The following table outlines the new out-of-office HSCs and the corresponding in-office HSCs.

New HSCs (out-of-office)

Use the following HSCs for services performed in

publicly funded facilities (e.g. hospitals)

Current HSCs (in-office)

Use the following HSCs for services performed in

self-funded facilities (e.g. community clinics,

registered rented offices in an AHS facility)

03.03AZ 03.03A

03.03BZ 03.03B

03.03FZ 03.03F

03.04AZ 03.04A

03.05IZ 03.05I

03.07AZ 03.07A

03.08AZ 03.08A

Number: MED 223 Date: March 30, 2020

Subject: Rates for new Facility Based Health Service Codes

Reference: MED 215

Bulletin Alberta Health Care Insurance Plan

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03.08BZ 03.08B

03.08IZ 03.08I

03.08JZ 03.08J

08.19AZ 08.19A

08.19GZ* 08.19G

08.19GA

08.45Z 08.45

*08.19GZ includes the skill modifiers and the service requirements of both 08.19G and 08.19GA.

What is the difference between the new out-of-office HSC rates vs. the current in-office HSCs?

The new rates for out-of-office facilities do not include compensation for facility costs such as rent, utilities,

equipment, supplies, staff wages, etc. However, the rates do reflect the overhead costs associated with

administrative expenses such as clerical support, payments to billing staff etc. The following schematic shows

the difference between the rate composition for “in-office” and “out-of-office” HSCs.

In-office rate composition:

Professional Fee Administrative Costs Facility Costs

Physician knowledge, skill, and

time fee

Costs associated with billing staff,

clerical support, etc.

Costs associated with facility– rent,

utilities, equipment, supplies, staff

wages etc.

Out-of-office rate composition:

Professional Fee Administrative Costs

Physician knowledge, skill, and

time fee

Costs associated with billing staff,

clerical support, etc.

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Who is impacted?

Who is not impacted?

Physicians who work exclusively in the community will not experience any changes as they will continue

submitting claims using the in-office HSCs.

Physicians who are part of a hospital-based specialty will not experience any changes to their rates (e.g.

infectious disease specialists, anesthesiologists, emergency medicine specialists etc.). However, they will still

be required to submit claims using the new HSCs.

Hospital-based physicians

Physicians who work exclusively in the hospital

but their current rates in the SOMB are based

on a community clinic setting. As such, they

receive compensation including facility costs

(e.g. hospital-based pediatricians).

They will be required to bill fee codes without

facility costs (Z codes).

Physicians with Offices in AHS Facilities

Physicians with registered offices in AHS

facilities will continue billing “in-office”

codes.

Physicians who pay rent to AHS may register

their office as a community office with a

discrete facility ID. By registering their office,

they will not be impacted by this change and

will be able to bill the “in-office” fee codes.

OR

Work with their Zone Medical Director at AHS

to discuss their current arrangements.

Hospital and Community Mix

Physicians who split their time between

community and hospital currently receive the

(higher) community rates for services

performed in hospital (e.g. ophthalmologists).

They will be required to bill fee codes without

facility costs (Z codes).

Note - Services performed in community clinics

will be claimed through the in-office codes and paid

at the current rates (no change).

Family Physicians in Rural Alberta

Family physicians in rural areas often split their

time between a community clinic and a hospital

emergency room.

Recognizing this situation, the rates for more

commonly billed limited visit (03.03A) and

comprehensive visit (03.04A) services are

matched with the current rates for these

services (rotational duty rates) paid to physicians

who work in other emergency rooms (Urgent

Care Centres) on regular basis.

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What are the rates for the out-of-office HSCs?

The following tables include rates for new “out-of-office” HSCs. Skill code definitions can be found after the

tables.

New Rates Effective March 31, 2020

HSC BASE RATE SKILL CODE EXPLICIT ACTION AMOUNT ($)

03.03AZ 18.50 ANES Replace Base 25.63

ANPA Replace Base 27.77

CARD Replace Base 37.35

CLIM Replace Base 42.84

CMSP Replace Base 42.84

CRSG Replace Base 27.18

CTSG Replace Base 27.18

DERM Replace Base 30.87

DIRD Replace Base 18.50

E/M Replace Base 33.72

EMSP Replace Base 30.63

FTER Replace Base 30.63

GAST Replace Base 52.10

GNSG Replace Base 25.67

GP Replace Base 31.00

HEM Replace Base 42.84

HEPA Replace Base 27.77

IDIS Replace Base 49.99

INMD Replace Base 42.84

MDBI Replace Base 27.77

MDGN Replace Base 42.08

MDMI Replace Base 27.77

MDON Replace Base 42.84

NCMD Replace Base 18.50

NEPH Replace Base 67.07

NEUR Replace Base 35.50

NPM Replace Base 42.08

NUPA Replace Base 27.77

NUSG Replace Base 26.45

OBGY Replace Base 29.25

OCMD Replace Base 42.84

OPHT Replace Base 36.71

ORTH Replace Base 25.88

OTOL Replace Base 28.80

OVAC Replace Base 36.71

PATH Replace Base 27.77

PDGE Replace Base 52.10

PDNR Replace Base 42.08

PDSG Replace Base 42.08

PED Replace Base 42.08

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HSC BASE RATE SKILL CODE EXPLICIT ACTION AMOUNT ($)

PEDC Replace Base 42.08

PEDN Replace Base 67.07

PHMD Replace Base 46.91

PLAS Replace Base 42.91

PSYC Replace Base 30.97

RHEU Replace Base 31.66

ROSP Replace Base 22.82

RSMD Replace Base 46.85

THOR Replace Base 31.86

UROL Replace Base 41.07

VSSG Replace Base 19.82

03.03BZ 29.25 All appropriate skills

03.03FZ 32.34 CARD Replace Base 71.24

CLIM Replace Base 48.96

CRCM Replace Base 32.34

E/M Replace Base 57.69

GAST Replace Base 52.10

HEM Replace Base 48.96

IDIS Replace Base 59.99

INMD Replace Base 48.96

MDGN Replace Base 70.14

MDON Replace Base 48.96

NEPH Replace Base 74.52

NEUR Replace Base 52.44

NPM Replace Base 70.14

PDGE Replace Base 70.14

PDNR Replace Base 70.14

PED Replace Base 70.14

PEDC Replace Base 71.24

PEDN Replace Base 70.14

PHMD Replace Base 89.91

RHEU Replace Base 44.42

RSMD Replace Base 82.13

UROL Replace Base 41.07

VSSG Replace Base 39.63

03.04AZ 31.71 ANES Replace Base 60.00

ANPA Replace Base 55.54

CARD Replace Base 66.76

CLIM Replace Base 134.64

CMSP Replace Base 134.64

CRSG Replace Base 106.45

CTSG Replace Base 106.45

DERM Replace Base 38.41

DIRD Replace Base 33.00

E/M Replace Base 86.54

EMSP Replace Base 53.92

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HSC BASE RATE SKILL CODE EXPLICIT ACTION AMOUNT ($)

FTER Replace Base 53.92

GAST Replace Base 70.07

GNSG Replace Base 51.35

GP Replace Base 90.21

HEM Replace Base 134.64

HEPA Replace Base 55.54

IDIS Replace Base 129.98

INMD Replace Base 134.64

MDBI Replace Base 55.54

MDGN Replace Base 84.17

MDMI Replace Base 55.54

MDON Replace Base 134.64

NCMD Replace Base 33.00

NEPH Replace Base 134.14

NEUR Replace Base 115.75

NPM Replace Base 84.17

NUPA Replace Base 55.54

NUSG Replace Base 40.69

OBGY Replace Base 48.74

OCMD Replace Base 134.64

OPHT Replace Base 78.07

ORTH Replace Base 49.84

OTOL Replace Base 42.06

OVAC Replace Base 78.07

PATH Replace Base 55.54

PDGE Replace Base 84.17

PDNR Replace Base 115.75

PDSG Replace Base 84.17

PED Replace Base 84.17

PEDC Replace Base 84.17

PEDN Replace Base 134.14

PHMD Replace Base 78.19

PLAS Replace Base 62.58

RHEU Replace Base 66.44

ROSP Replace Base 62.76

RSMD Replace Base 77.29

THOR Replace Base 31.86

UROL Replace Base 54.76

VSSG Replace Base 31.71

03.05IZ 38.19 All appropriate skills

03.07AZ 33.23 ANES Replace Base 58.48

ANPA Replace Base 55.54

CARD Replace Base 79.37

CLIM Replace Base 85.68

CMSP Replace Base 111.27

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HSC BASE RATE SKILL CODE EXPLICIT ACTION AMOUNT ($)

CRCM Replace Base 73.77

CRSG Replace Base 57.75

CTSG Replace Base 57.75

DERM Replace Base 33.23

E/M Replace Base 86.54

EMSP Replace Base 60.04

FTER Replace Base 60.04

GAST Replace Base 105.10

GNSG Replace Base 51.35

GP Replace Base 48.59

HEM Replace Base 85.68

HEPA Replace Base 55.54

IDIS Replace Base 149.97

INMD Replace Base 85.68

MDBI Replace Base 55.54

MDGN Replace Base 84.17

MDMI Replace Base 55.54

MDON Replace Base 85.68

NEPH Replace Base 112.22

NEUR Replace Base 77.17

NPM Replace Base 84.17

NUPA Replace Base 55.54

NUSG Replace Base 56.96

OBGY Replace Base 48.74

OCMD Replace Base 85.68

OPHT Replace Base 67.94

ORTH Replace Base 54.59

OTOL Replace Base 46.61

PATH Replace Base 55.54

PDGE Replace Base 84.17

PDNR Replace Base 84.17

PDSG Replace Base 84.17

PED Replace Base 84.17

PEDC Replace Base 84.17

PEDN Replace Base 84.17

PHMD Replace Base 78.19

PLAS Replace Base 35.76

RHEU Replace Base 60.01

RSMD Replace Base 79.17

THOR Replace Base 43.81

UROL Replace Base 54.76

VSSG Replace Base 79.28

03.08AZ 64.97 ANES Replace Base 115.00

ANPA Replace Base 111.09

CARD Replace Base 120.75

CLIM Replace Base 153.00

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HSC BASE RATE SKILL CODE EXPLICIT ACTION AMOUNT ($)

CMSP Replace Base 153.00

CRCM Replace Base 164.67

CRSG Replace Base 160.80

CTSG Replace Base 160.80

DERM Replace Base 64.97

E/M Replace Base 140.49

EMSP Replace Base 122.55

FTER Replace Base 122.55

GAST Replace Base 147.69

GNSG Replace Base 124.08

GP Replace Base 90.70

HEM Replace Base 153.00

HEPA Replace Base 111.09

IDIS Replace Base 199.97

INMD Replace Base 153.00

MDBI Replace Base 111.09

MDGN Replace Base 140.28

MDMI Replace Base 111.09

MDON Replace Base 153.00

NEPH Replace Base 178.85

NEUR Replace Base 154.33

NPM Replace Base 140.28

NUPA Replace Base 111.09

NUSG Replace Base 101.73

OBGY Replace Base 73.11

OCMD Replace Base 153.00

OPHT Replace Base 96.70

ORTH Replace Base 89.00

OTOL Replace Base 81.47

PATH Replace Base 111.09

PDGE Replace Base 140.28

PDNR Replace Base 140.28

PDSG Replace Base 140.28

PED Replace Base 140.28

PEDC Replace Base 140.28

PEDN Replace Base 210.41

PHMD Replace Base 156.37

PLAS Replace Base 71.52

RHEU Replace Base 132.91

ROSP Replace Base 74.55

RSMD Replace Base 172.07

THOR Replace Base 147.38

UROL Replace Base 75.30

VSSG Replace Base 126.84

03.08BZ 73.11 All appropriate skills

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HSC BASE RATE SKILL CODE EXPLICIT ACTION AMOUNT ($)

03.08IZ 8.59 CARD Replace Base 8.59

CLIM Replace Base 36.72

E/M Replace Base 39.33

GAST Replace Base 33.77

HEM Replace Base 36.72

IDIS Replace Base 49.99

INMD Replace Base 36.72

MDON Replace Base 36.72

NEPH Replace Base 36.42

NEUR Replace Base 35.50

PHMD Replace Base 39.09

RHEU Replace Base 26.96

RSMD Replace Base 37.32

03.08JZ 42.08 All appropriate skills

08.19AZ 52.22 GNMH Replace Base 52.22

PSYC Replace Base 147.87

08.19GZ 34.70 GP Replace Base 34.70

PED Replace Base 35.07

GNMH Replace Base 44.01

PSYC Replace Base 44.01

SPMH Replace Base 44.01

08.45Z 48.75 GNMH Replace Base 48.75

GP Replace Base 111.06

NPM Replace Base 144.79

PDGE Replace Base 144.79

PDNR Replace Base 144.79

PDSG Replace Base 144.79

PED Replace Base 144.79

PEDC Replace Base 144.79

PEDN Replace Base 144.79

PSYC Replace Base 163.14

HSC Type Code Action Amount ($)

08.45Z CALL M15NPM

1 Replace 144.79

2-10 For Each Call Increase By 46.36

CALL M15PDC

1 Replace 144.79

2-10 For Each Call Increase By 46.36

CALL M15PDG

1 Replace 144.79

2-10 For Each Call Increase By 46.36

CALL M15PDN

1 Replace 144.79

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2-10 For Each Call Increase By 46.36

CALL M15PDS

1 Replace 144.79

2-10 For Each Call Increase By 46.36

CALL M15PED

1 Replace 144.79

2-10 For Each Call Increase By 46.36

CALL M15PSY

1 Replace 163.14

2-10 For Each Call Increase By 69.73

Skill Code Definitions:

Specialty Specialty Name

ANES Anesthesia

ANPA Anatomical Pathology

CARD Cardiology

CLIM Clinical Immunology & Allergy

CMSP Community Medicine - Specialty

CRCM Critical Care Medicine

CRSG Cardiac Surgery

CTSG Cardio and Thoracic

DERM Dermatology

DIRD Radiology

E/M Endocrinology/Metabolism

ECGC Electrocardiogram Interpretation - Cardiology

EMSP Emergency Medicine

FTER Full Time Emergency Room

GAST Gastroenterology

GEMD Geriatric Medicine

GNMH Generalists Mental Health Physicians

GNSG General Surgery

GP General Practice

HEM Hematology

HEPA Hematology

IDIS Infectious Diseases

IMCE Internal Medicine Certification

INMD Internal Medicine

MDBI Medical Biochemistry

MDGN Medical Genetics

MDMI Medical Microbiology

MDON Medical Oncology

NCMD Nuclear Medicine

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Skill Code Definitions:

Specialty Specialty Name

NEPH Nephrology

NEUR Neurology

NPM Neonatal Perinatal Medicine

NUPA Neuropathology

NUSG Neurosurgery

OBGY Obstetrics

OCMD Occupational Medicine

OPHT Ophthalmology

ORTH Orthopedic Surgery

OTOL Otolaryngology

OVAC Oculo-visual Assessment Certification

PATH Pathology

PDGE Pediatric Genetics

PDNR Pediatric Neurology

PDSG Pediatric General Surgery

PED Pediatrics

PEDC Pediatric Cardiology

PEDN Pediatric Nephrology

PHMD Phys Med and Rehab

PLAS Plastic Surgery

PSYC Psychiatry

RHEU Rheumatology

ROSP Radiation Oncology - Specialty

RSMD Respiratory Medicine

SPMH Specialists Mental Health Physicians

THOR Thoracic Surgery

UROL Urology

VSSG Vascular Surgery

Inquiries:

Any inquiries regarding this change can be sent to health-pcsp.admin@gov.ab.ca.

Submitting Claims

These changes are effective March 31, 2020. CLASS is updated and the revised Schedule of Medical

Benefits including the out-of- office HSCs will be posted online.

You may submit claims for these new codes starting March 31, 2020.

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Contact: Provider Compensation and Strategic Partnerships Branch

Approval: Camille Bailer

Email:

health-pcsp.admin@gov.ab.ca Position: Executive Director Provider Compensation and Strategic Partnerships Branch