A Guide to MSB Billing Codes for Virtual Care

Over the past year, in response to the COVID-19 pandemic, the Saskatchewan Ministry of Health (MOH) has made frequent updates to several billing codes. In this post, we’ll explain the most recent updates on MSB billing codes for virtual care and share some guidance on billing these codes to ensure you are getting paid for the care you are providing.

We have broken the post out into two sections: 

1. Virtual Care Codes for Family Physicians
2. Virtual Care Codes for Specialists

 

1. MSB Billing Codes: Virtual Care Codes for Family Physicians   

On January 1, 2021 the MOH announced new virtual care codes for family physicians to use moving forward. These new MSB billing codes replace the existing 510/515A service codes. For virtual care services provided between March 13, 2020 and December 31, 2020, physicians must continue to bill the 510A/515A service codes.

The virtual care codes for family physicians are separated into two parts: 

• General services 
• General practices   

General Services  

The general services section has only one code: 875A. This code is used for limited virtual care visits provided via videoconference only (not telephone) and is used for maximum of one per patient per day. This billing code cannot used with any additional MSB billing codes, virtual or in-person, by the same physician on the same day. 

Fee code	Description	Value
875A	Limited virtual care visit (patient to physician) provided via secure videoconference	$24.50

Some things to note:  

• Service must be initiated by the patient. 
• The 875A MSB billing code is payable to physicians providing episodic care initiated by a patient via a virtual care clinic that does not provide in-person physician services.  
• This code is not payable for services performed by a medical learner under the supervision of a physician. 

General Practice  

The general practice section includes seven MSB Billing codes and can be used for any of the following services via telephone or secure videoconference: 

Fee code	Description	Value
805B	Virtual partial assessment or subsequent virtual visit provided via telephone or secure videoconference	$35
855B	Virtual partial assessment or subsequent virtual visit provided via telephone or secure videoconference, involving a specialist referral	$35
809B	Virtual consultation provided via telephone or secure videoconference	$67.50
811B	Repeat virtual consultation provided via telephone or secure videoconference	$32.75
840B	Virtual counselling provided via telephone or secure videoconference – first 15 minutes	$33.75
841B	Virtual counselling provided via telephone or secure videoconference – next 15 minutes or major portion thereof.	$33.75
864B	Virtual Chronic Disease Management provided via telephone or secure videoconference	$41.30

For details on the requirements for virtual care MSB billing codes for family physicians, download our Quick Reference Guide here. 

2. MSB Billing Codes: Virtual Care Codes for Specialists  

For specialists, the MOH announced 10 codes that can be used for billing their virtual care services. These billing codes are separated into three categories: 

• Specialist telephone and video assessments 
• Specialist consultation or visit via telephone or video 
• Psychotherapy and other psychiatric services via telephone or video 

Specialist Telephone and Video Assessments  

On January 1, 2021, the MOH announced that going forward, the 510A/515A MSB billing codes for pandemic telephone and video assessments are payable only to specialists.  

Specialist physicians are responsible for ensuring appropriate documentation for both assessments including: 

1. Date and time of service; 
2. Patient name;
3. Patient HSN;
4. Relevant clinical detail including symptoms, diagnosis, treatment, and follow-up.

Fee Code	Description	Value
510A	Pandemic telephone assessment	$35
515A	Pandemic video assessment	$35

Things to note: 

• Specialist physicians can be paid for medically required telephone and video assessments not restricted to a diagnosis specific to COVID-19. 
• A maximum of two assessments (telephone, video, or a combination) are billable per patient per day. 
• These codes cannot be billed in combination with any additional service codes. 

Specialist Consultation or Visit via Telephone or Video 

Five new MSB billing codes have been created for categories of communication between specialist physicians and an established patient or a new patient seeking medically required care.  

A specialist consultation or visit includes: 

1. Comprehensive assessment of a patient’s condition including complete history, symptoms, diagnosis, treatment and follow-up;
2. Review of laboratory and/or other data; 
3. Written submission of the specialist’s opinion; 
4. Recommendations to the referring doctor (when patient is referred); and 
5. Advice to the patient. 

Fee Code	Description	Value
350A	Pandemic Virtual Care: Specialist consultation provided via telephone — first 30 minutes of direct physician–patient care or major part thereof	$120
351A	Pandemic Virtual Care: Specialist consultation provided via secure video conference — first 30 minutes of direct physician–patient care or major part thereof	$120
353A	Pandemic Virtual Care: Specialist visit provided via telephone — first 15 minutes of direct physician–patient care or major part thereof	$52
354A	Pandemic Virtual Care: Specialist visit provided via secure video conference — first 15 minutes of direct physician–patient care or major part thereof	$52
355A	Pandemic Virtual Care: Specialist consultation or visit provided via telephone or secure video conference — each subsequent 15 minutes of direct physician–patient care or major part thereof, bill units (to a maximum of 2 additional units)	$56.10

Some things to note:  

• All time requirements/calculations are for direct physician-patient interaction only. 
• Billings for virtual care services performed by medical learners must include the comment: “supervision of medical learner”. 
• Physicians are responsible to ensure appropriate documentation  

Psychotherapy and Other Psychiatric Services via Telephone or Video 

Three new codes were introduced for billing communications between a physician and an established patient or a new patient seeking medically required psychotherapy and other psychiatric services during a pandemic. The virtual psychotherapy or psychiatric services must be a minimum of 15 minutes of medically required direct patient interaction via telephone or secure videoconference to a maximum of 8 units (2 hours) per patient, per day. 

The psychotherapy or psychiatric service may also include: 

1. Psychotherapy (as defined in the Payment Schedule), including family or group psychotherapy. 
2. Psychiatric care (as defined in the Payment Schedule); 
3. Psychiatric counselling; and, 
4. Advanced Primary Health Care for Pediatric Patients – Psychiatric Care. 

Fee code	Description	Value
356A	Pandemic Virtual Care: Psychotherapy and other psychiatric services provided via telephone — first 15 minutes of direct physician-patient care	$56.10
357A	Pandemic Virtual Care: Psychotherapy and other psychiatric services provided via secure video conference — first 15 minutes of direct physician-patient care	$56.10
358A	Pandemic Virtual Care: Psychotherapy and other psychiatric services provided via telephone or secure video conference — each subsequent 15 minutes of direct physician-patient care or major portion thereof, bill units (to a maximum of 7 additional units per patient/per day)	$56.10

Some things to note: 

• These codes are billable by physicians with entitlement to bill 33E-39E, 100E, 101E, 110E, 111E or 163B/164B. 
• All time requirements/calculations are for direct physician-patient interaction only. 
• Billings for virtual care services performed by medical learners must include the comment: “supervision of medical learner”. 
• Physicians are responsible for ensuring appropriate documentation (that must include start and stop time) according to the “Documentation Requirements for the Purposes of Billing”. 

For details on the requirements for each of the virtual care billing codes, download our virtual care for specialists 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.