Recently, the Government of Alberta introduced the Primary Care Physician Compensation Model (PCPCM), a new payment model for family physicians. This model provides an alternative to the traditional Fee-For-Service (FFS) structure, designed to better reflect the full scope of a physician’s work, including indirect care and administrative responsibilities, while promoting long-term, comprehensive patient care.
The PCPCM introduces a meaningful shift in how physicians are compensated in Alberta. This change provides physicians with an opportunity to align compensation with the realities of everyday practice, while supporting improved patient outcomes and a more sustainable primary care system throughout Alberta.
PCPCM Billing Breakdown: How the New Compensation Model Works
Compensation under the PCPCM is based on three key components:
- 40% from patient encounters (in-person, virtual, consults)
- 40% from direct and indirect care time
- 20% from complexity-adjusted panel payments
Physicians can expect an estimated 25% increase in annual income, along with added compensation for work done outside the exam room. The model is designed to support a more patient-focused approach, resulting in improved outcomes and a stronger emphasis on preventive care.
How Encounter Billing Works Under Alberta’s PCPCM
Most services under the PCPCM fall under in-basket health service codes, which are reimbursed at 68.5% of the standard FFS rate. For example:
- 03.03A (Assessment Visit)
- Standard FFS rate: $39.49
- PCPCM rate: $39.49 x 0.685= $27.05
All services not included in the in-basket list are considered out-of-basket and paid at 100% of the FFS rate. These can be submitted to AHCIP with applicable complexity modifiers. Common examples include:
- 75.64 – Vasectomy
- 03.7BA – MAID (Determination Phase)
- 03.03NA – Home visits to patients in assisted living or personal care homes
In some cases, billing under FFS may offer a higher return, particularly when time-based modifiers can be applied.
How to Bill Time-Based Services Under Alberta’s PCPCM
The PCPCM compensates physicians for the time spent delivering both direct and indirect care. Claims are billed in 15-minute increments, and time is tracked cumulatively throughout the day.
- Base rate: $26.25 per 15 minutes or $105/hour for all patient care
- After-hours premium: Additional $21.93 per 15 minutes or $87.72/hour
- Applies weekdays (5–11 p.m.) and weekends/stat holidays (7 a.m.–11 p.m.).
- Capped at 20% of total time claimed annually.
- The majority of after-hours services must be in person.
Physicians also receive a 10% practice management fee, which is automatically calculated based on the total reported hours. For example, a 50-hour care week earns an additional $525.
Important: Time-based claims must be submitted to AHCIP using your PCPCM Business Arrangement (BA)and within 90 days of service. Submissions through your FFS BA will be rejected.
Time-based billing is only permitted for panelled patients and does not apply to uninsured services or out-of-basket procedures, such as vasectomies, which are already paid at 100% fee-for-service.
PCPCM Time Codes Usage, Rates and Eligible Activity
Physicians can claim time, including time with out-of-province patients, when the majority of patients seen during the day are part of their panel.
Direct Care codes (PC001, 003, 004) cannot be claimed for time spent on out-of-basket services and exclude services and encounters with out-of-country patients. Up to 20% of total time-based billing per fiscal year can be assigned to premium-rate Direct Care Codes (PC003 and PC004).
Time Code | Usage | Rate (per 15 minutes) | Eligible Activities |
Direct Care (PC001) | Monday – Friday 7am to 5pm excludes holidays Max calls per day: 40 | $26.25 | Direct care to patients: – In-person – Video – Phone Charting between appointments that took place between 7am and 5pm on weekdays |
Indirect Care (PC002) | Unrestricted Max calls per day: 44 | $26.25 | Indirect care
The patient does not have to be present in the clinic or have an encounter with the physician on the same day. Claims are not limited to services found in the SOMB. |
After-Hours Direct Care (PC003) | Monday – Friday 5pm to 11pm excludes holidays Max calls per day: 24 | $48.18 | Direct care to patients: – In-person – Video – Phone (urgent) Charting between appointments that took place between 5pm and 11pm on weekdays |
Weekend & Holiday Direct Care (PC004) | Weekends & Holidays 7am to 11pm Max calls per day: 64 | $48.18 | Direct care to patients: – In-person – Video – Phone (urgent) Charting between appointments that took place between 7am and 11pm on weekdays |
Panel Payments in PCPCM: Monthly Capitation Based on Patient Complexity
Panel payments account for the final 20% of compensation under the PCPCM. These are based on the number and complexity of patients assigned to a physician’s panel, using CIHI Population Grouper methodology.
- Average annual payment per patient: $70.25
- Range: $32.87 to $136.73, depending on patient complexity
- Payments: Issued monthly (1/12th of the annual rate)
To ensure accurate payment, physicians must upload their patient panel to CPAR via their EMR between the 1st and 21st of each month.
Maintaining an up-to-date panel is key to optimizing your capitation payments. Check the upload schedule by EMR.
Considering Switching to PCPCM? We’re Here to Support You
At DoctorCare, we have been supporting physicians across Canada with payment model transitions for nearly a decade. With the right support, you can reduce administrative burden, maximize revenue, and keep your practice running efficiently throughout the transition.
Contact us to book a complimentary income analysis with our team today. We will help you assess whether the PCPCM is the right fit for your practice and ensure you are set up for success under the new model.
