Manitoba Health has made many updates and changes to tariffs to address challenges related to the COVID-19 pandemic over the past couple of years. In this post, we’ll share the most recent updates on tariffs relating to virtual care and COVID-19. We’ll also share some tips on how to best bill tariffs to ensure you are getting paid for the care you are providing.
We have broken the post out into four sections:
1. ICD-9 Codes for COVID-19
On March 30, 2020, the Manitoba Health, Seniors and Active Living announced three ICD-9 codes for physicians to use for medical claims to help with monitoring medical conditions related to COVID-19.
|V0182||Exposure to COVID-19|
|07982||COVID-19 Assoc Coronavirus|
|4803||Pneumonia due to COVID-19|
2. Virtual Visit Tariffs
Eleven new temporary virtual visit tariffs have been announced for physicians in place of in-clinic services. The duration of these tariffs will be determined by Manitoba Health.
|8284||Virtual visit by telephone or video – patient aged 65-69 years||$40.10|
|8285||Virtual visit by telephone or video – patient aged 70 years or over||$44.30|
|8321||Virtual visit by telephone or video||Paid equivalent to bloc’s regional history or exam|
|8442||Comprehensive virtual assessment by general practitioner||Rate equivalent to 8540, 8424, 8500|
|8447||Comprehensive virtual assessment by a specialist||Paid equal to tariff 8540, 8503, 8504, 8543, or 8544 for the physician’s bloc of practice|
|8521||Virtual consultation telephone or video, involving child or geriatric patients, by a psychiatrist||Paid equal to the consultation tariffs 8622, 8554|
|8527||Chronic care virtual visit by telephone or video||$33.45|
|8533||Virtual psychotherapy by telephone or video||$49.40|
|8535||Virtual consultation by telephone or video||Paid equivalent to blocs’ 8550, 8553, 8556, 8516, 8617, 8557|
|8655||Virtual psychotherapy by telephone or video||$40|
|8786||Virtual psychiatric care by telephone or video||$62.40|
- Services must be provided personally by the physician. No claim may be made for a virtual visit in which only a physician proxy participates, such as a nurse or clerk.
- After Hours Premiums may not be claimed in addition, except for urgent or emergent communications.
- Start and stop times must be documented in the patient’s chart and included on the claim.
- Rural/Northern/Brandon Fee differentials apply.
Special Circumstance Indicators
In addition to the virtual visit tariffs, physicians must also fill in one of the four following values in the special circumstance indicators field for the medical services provided via virtual care.
|U||Virtual Chronic Pain Management Services billing benefit 78321 in place of 78570 only|
|V||Virtual Chronic Pain Management Services billing benefit 78321 in place of 78571
Child Development Assessment Services billing benefit 78321 in place of 78404, 78552, 78555, 78558
|W||Virtual Geriatric Consultation billing benefit 78535 in place of 78617 only|
|X||Virtual Anesthetic Consultation billing benefit 78535 in place of 78516 only|
Note: Virtual visit tariff 78321 for Virtual Child Development Assessment Services and Virtual Chronic Pain Management Services billed with special circumstance indicator U or V will require the actual start time, and a calculated stop time.
We have created a Quick Reference Guide of all the virtual visit tariff codes. You can download it here.
3. COVID-19 Vaccine Tariffs
In support of the vaccine roll out, Manitoba Health has announced temporary tariffs for the administration of the COVID-19 vaccines. The tariffs must be submitted to MHSAL within two business days of service delivery.
|8251||Pfizer-BioNTech – per dose||$20|
|8252||Moderna – per dose||$20|
|8255||Johnson & Johnson – per dose||$20|
|8256||Astra-Zeneca – per dose||$20|
|8292||Pediatric Pfizer BioNTech – per dose||$20|
|8293||Moderna booster – per half dose||$20|
The tariffs cover:
- Injection of the vaccine,
- Verifying each patient meets provincial eligibility criteria,
- Obtaining patient consent, and
- Additional administrative requirements, such as submitting claims within 48 hours and weekly detailed reporting.
- Physicians must report the eligibility criteria for immunization on the claim in accordance with Public Health guidelines.
- Physicians must report vaccine inventory to Public Health on a weekly basis and/or as directed by Public Health. The system for inventory reporting will be determined by Public Health and communicated to physicians.
- Physicians are required to schedule a second dose appointment with patients following administration of the first dose. Physicians are required to reasonably follow-up with patients to ensure the second dose is administered within recommended guidelines.
- Physicians shall provide equitable access for vaccinations for all eligible Manitobans regardless of whether the patient is in the physician’s existing panel of patients.
- After Hours Premiums may not be claimed in addition.
Special Circumstance Indicators
Physicians are required to provide an immunization reason on all COVID-19 vaccination claims. The special circumstances indicator field should be populated using one of the reasons listed below when submitting a claim:
1 = Personal Care Home Resident
2 = Health Care Worker
3 = Community with disproportionate disease impact
4 = Congregate living, other
5 = Routine (age-based indication)
6 = Essential Worker
7 = Pre-existing Condition
COVID-19 Immunization Hesitancy Advice
On July 12, 2021, the Ministry announced a new tariff payable for COVID-19 immunization advice provided in person to patients who have not received a COVID-19 vaccine.
|8330||COVID-19 Immunization hesitancy advice||$37.80|
This tariff should only be claimed on the same day as another in person visit, and requires a minimum of 10 minutes spent providing vaccine advice and counselling.Advice may include, but is not limited to, discussions on indications, contraindications, benefits and risks of immunization, questions concerning immunization in general, questions regarding a specific vaccine product, or addressing concerns about after effects.
To read more about the specific requirements involved in billing vaccine related tariffs, download our Quick Reference Guide here.
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.