Provincial Perinatal High Risk Unit

The fees listed are only applicable to patients who are admitted to the unit and have been designated as high risk and are payable only to the physician in charge of the patient. The Concurrent Care fee for ICU, fee code 51790, may also be claimed by a second obstetrical specialist sharing in the on-going care of the patient.

DIAGNOSTIC AND THERAPEUTIC SERVICES 

This section of the Schedule identifies the amounts payable for miscellaneous professional services. Designation of site for claiming the service is based on where the procedure is performed rather than where it is interpreted.

f a procedure is performed in a hospital and is listed both in this section and the In-Hospital Diagnostic Section, it must be claimed using the fee code listed in the In-Hospital Diagnostic Section.

When a procedure(s) is the sole reason for a visit, no consultation or visit fees should be charged. However, fee code 54000 may be claimed, unless stated otherwise.

Billing rules for immunization of beneficiaries who belong to target populations designated by the DHCS are as follows:

(a) visit for assessment plus single immunization - claim visit fee only,

(b) visit for assessment plus two immunizations - claim visit fee plus one unit of fee code 54656, 

(c) visit for immunization against influenza and pneumococcal disease - claim one unit of 54650 and one unit of 54656,

(d) visit for immunization against influenza only - claim one unit of fee code 54650, and 

(e) visit for immunization against pneumococcal disease only - claim one unit each of fee codes 54000 and 54658.  

Satellite Haemodialysis

(a) Fee codes 54494 and 54496 are benefits for managing chronic haemodialysis where the patient undergoes dialysis at a DHCS approved satellite site remote from the site where the billing physician is located. 

(b) For the purpose of claiming these codes “remote” means patient and physician are located in different municipalities and the physician does not attend the patient’s dialysis sessions at the satellite site in person.

(c) All claims for fee codes 54494 and 54496 must include the facility number of the satellite site where the patient is located. See the MCP Physician Information Manual for a list of numbers.