Over the past year as a result of the COVID-19 pandemic, the way in which physicians provide medical care in Alberta has evolved drastically. The Alberta government introduced new Alberta virtual billing codes to allow physicians to continue providing care over telephone and video conference and announced codes (without limitations) will remain in the Schedule of Medical Benefits permanently.
In this post, we’ll share some tips on how to best bill for virtual care to ensure you are getting paid for the care you are providing.
Virtual Care Codes (without limitations)
| Code | Description | Rate |
| 03.01AD | Advice to patient or their agent via telephone, email and video conference including virtual care during a viral epidemic. Maximum 1 per patient per physician per day. | $20 |
| 03.03CV | Assessment provided by General Practitioners (GP) and Specialists via telephone or secure video conference; 10+ minutes physician: patient direct time. Rates will be equal to an in-person limited assessment (HSC 03.03A) and vary by skill. | Base rate: $25.09 |
| 03.03FV | Follow up assessments (visits), for referred patients only, provided by specialists via telephone or secure video conference; 10+ minutes physician: patient direct time. Rates will be equal to an in-person follow-up assessment (HSC 03.03F) and vary by skill. | Base rate: $32.34 |
| 03.08CV | Comprehensive consultations provided via telephone or secure video conference; consultation requirements apply. Rates will be equal to an in-person comprehensive consultation (HSC 03.08A) and vary by skill. | Base rate: $79.23 |
| 08.19CX | Comprehensive psychiatric consultation provided via telephone or secure video conference; consultation requirements apply. Rates will be equal to an in-person psychiatric consultation (HSC 08.19A) and vary by skill. | Base rate: $52.22 |
| 08.19CV | Psychotherapy and other psychiatric services (such as group therapy) provided via telephone or secure video conference by a Psychiatrist or a Generalist in Mental Health. Rates will be equal to an in-person psychiatric assessment (HSC 08.19GA) and vary by skill. | Base rate: $44.01 |
| 08.19CW | Psychotherapy and other psychiatric services (such as group therapy) provided via telephone or secure videoconference by a GP or Pediatrician, per full 15 minutes. Rates will be equal to an in-person psychiatric assessment (HSC 08.19G) and vary by skill. | Base rate: $47.54 |
Virtual Care Codes (with limitations)
| Code | Description | Rate |
| 03.05JR | Physician telephone call directly to patient to discuss test results. Maximum of 14 per week per physician. | $20 |
| 03.01S | Physician to patient secure electronic communication. Maximum 1 per patient per week to a maximum 14 per week per physician. | $20 |
| 03.01T | Physician to patient secure video conference. Maximum 1 per patient per week to a maximum 14 per week per physician. | $20 |
Alberta Virtual Care Billing Tips and Requirements
Here are some tips and requirements to help physicians bill for virtual care:
- Visits. Visits must be initiated by your patient or their agent (i.e., family, spouse, guardian, etc.) meaning that the patient or their agent has either booked the appointment or requested to see you virtually.
- Consultations. Consultations are considered initiated on the patient’s behalf by virtue of the consultation request.
- Location of the service. Location of service is your location at the time of the service. For example, if you provide service while working at home, select “Home”.
- Only physician to patient time can be claimed. If you choose to complete charting/referral letters after the patient visit/consultation appointment has concluded, you cannot claim this time.
- Limit of one virtual visit per patient, per physician, per day may be claimed. Virtual codes cannot be billed with other virtual services or in-person services provided on the same day, by the same physician, for the same patient.
- Additional premiums. Additional premiums such as age modifiers, complex modifiers, after-hours time premium, prolonged codes, Business Cost Program (BCP) and Rural Remote Northern Program (RRNP) will not apply to virtual codes.
- Virtual services 10 minutes or less. Virtual services that are 10 minutes or less MUST be claimed using 03.01AD, regardless if the service was related to COVID-19.
- TELES. The telehealth modifier TELES, does NOT apply to any temporary virtual codes.
- General COVID-19 information. None of the above virtual codes may be claimed for providing general information on COVID-19.
- Limitations of “V” category code. Virtual care codes do not apply to the limitations of “V” category code as they relate to the Daily Cap for office, home and unregistered facilities.
Alberta Medical Billing Update – January 2022
On January 12, 2022, Alberta Health has announced new changes to the virtual care billing codes relating to indirect care and complex modifiers.
Indirect Care
Physician provided indirect care/patient management services that are related to the provision of an insured service may be included in the time calculations for virtual services.
| Code | Eligible Specialities | Change |
| 03.01AD 03.03CV 03.03FV 03.08CV |
All physicians who provide both in-person and virtual care as part of their practice. | Time spent on patient management services can be counted towards the time requirements for relevant virtual care HSCs. |
Note: In order to be eligible to claim for patient management time, all services must have been completed on the same date of service as the patient virtual visit; only physician time can be claimed.
Complex Modifiers
Physicians can now bill a single complex modifier for eligible virtual visits and consultations.
| Code | Eligible Specialities | Change |
| 03.03CV | Family physicians meeting criteria | May bill CMGP01 for a virtual limited assessment when the total time spent providing patient care is at least 15 minutes (No additional calls of CMGP are allowed). |
| 03.03CV | Specialists meeting criteria from the following specialty groups: – Community medicine – Geriatric medicine – Occupational medicine – Radiation oncology – Cardiology – Endocrinology / metabolism – Hematology – Infectious diseases – Internal medicine – Medical oncology – Nephrology – Pediatrics – Pediatric cardiology – Rheumatology |
May bill CMXv15 for a virtual limited assessment when the total time spent providing patient care is at least 15 minutes. |
| 03.03CV | All remaining specialities not listed above. | May bill CMXV20 for a virtual limited assessment when the total time spent providing patient care is at least 20 minutes. |
| 03.03FV | Specialties meeting criteria from the following specialty groups: – Cardiology – Endocrinology / metabolism – Hematology – Infectious diseases – Internal medicine – Medical oncology – Nephrology – Pediatric cardiology – Pediatrics – Rheumatology |
May bill CMXV20 for a virtual follow-up assessment when the total time spent providing patient care is at least 20 minutes (referred cases only). |
| 03.08CV | All physicians meeting criteria for referred cases only. | May bill CMXC30 for virtual consultations when the total time spent providing patient care is at least 30 minutes. |
DoctorCare helps doctors sort through confusing billing rules, automate billing submissions, ensure errors are fixed, and optimize billings to maximize revenue. If you are interested in learning more about how we can help, contact us to set up a free consultation.
