A high risk prenatal assessment is an assessment by a maternal-fetal medicine
specialist requiring a minimum of 20 minutes in direct contact with the patient for the
management of a documented significant maternal and/or fetal risk factor(s) where
the mother and/or fetus are at significant risk for serious complications during the
pregnancy. The service is eligible for payment only if start and stop times of the
service are recorded in the patient’s permanent medical record.
Home Visits by General Practitioners
An Elective Home Visit rendered by a General Practitioner is a visit to a patient’s home or
normal place of residence which is initiated by the physician in the management of known
illness. The fee for elective home visits is the same regardless of the time that the service is
rendered, or the type of service provided.
A Non-Elective Home Visit rendered by a General Practitioner is a visit that is requested by
the patient or by the patient’s attendant and which is made by the physician on the same day.
The fee payable for a non-elective home visit is determined by the time or day that the
service is rendered. The time of service must be documented on the record for the visit.
For Extra Patient(s) Seen, only fee code 252 or 292 as applicable may be claimed.
In-Patient Surcharges
Fee code 355 may be claimed by General Practitioners providing continuing care of hospital
in-patients. It is payable during the first seven days of an admission on a per diem basis. It
can be billed in addition to the applicable admission assessment code, or SHV code, and
code 359.
Fee code 359 may be claimed by General Practitioners providing continuing care of hospital
in-patients. It is payable once during a period of admission on the day the patient is
discharged from hospital. It can be billed in addition to the applicable SHV code and code
355. The billing physician is responsible for preparing the discharge summary, the
discharge prescriptions and follow up care as necessary.
