Understanding MSP Billing Codes for COVID-19, Virtual Care, and Telehealth

The COVID-19 pandemic has posed a lot of challenges to physicians over the past year. We found that even doctors who have been using MSP Telehealth codes for many years, are finding it difficult to keep up to date with all the updates and changes to billing codes announced by the Ministry.

In this post, we will share an update on changes made to the MSP billing codes relating to COVID-19 and Telehealth along with some best practice recommendations to ensure you get  paid for the services you provide. We have broken down our post into five sections:

  1. COVID-19 Immunization Fee Codes
  2. COVID-19 Temporary Office Visit Fee Codes
  3. Communication and Virtual Care Fee Codes
  4. MSP Billing Codes for Telehealth
  5. Personal Health Risk Assessment and Chronic Disease Management services Codes Now Available on Telehealth

1. COVID-19 Immunization Fee Codes

The temporary fee codes for COVID-19 immunizations are effective for dates of service on or after January 25, 2021.

Fee CodeDescriptionValue
T10042Allow physicians to bill for COVID-19 immunizations done in addition to an in-person visit for an unrelated reason (office visit, prenatal visit, counselling, consultation, etc).$5.43
TB10043Allow physicians to bill for COVID-19 immunizations done without a visit for an unrelated reason, if the visit takes 10 minutes or less.$14
TB10044Billed together with 10043. Allow physicians to bill COVID-19 immunizations done without a visit for an unrelated reason, if the visit takes more than 10 minutes.$17.62

For regular updates and information relating to COVID-19 immunizations you can refer to the toolkit developed for Canadian family physicians at https://covidtoolkit.ca/.

2. COVID-19 Temporary Office Visit Fee Codes

There are two temporary office visit fee codes that are payable only for in-office visits with patients displaying suspected or active COVID-19 symptoms. They are not payable in addition to another face-to-face visit for the same patient on the same day. However, they can be billed in addition to a telephone or video visit on the same day.

Fee CodeDescriptionValue
T13701Office Visit for COVID-19 with test$50
T13702Office Visit for COVID-19 without test$40

3. Communication and Virtual Care Fee Codes

Three new temporary fee codes have been created for communication and virtual care: T13706 and T13708. These codes are similar to existing GPSC fees but expand accessibility and increase capacity to provide virtual care. The fee code T13708 was created to better enable communication between providers during the COVID-19 pandemic.

Fee CodeDescriptionValue
T13706FP Delegated Patient Telehealth Management Fee$20
T13707FP Email/Text/Telephone Medical Advice Relay or ReRX Fee$7
T13708FP COVID-19 communication with specialist and/or allied care provider$40

We put together a one-page quick reference guide with the details on the COVID-19-related fee codes mentioned above. Download it here.

4. MSP Billing Codes for Telehealth

The Telehealth fee MSP billing codes are used when services are rendered over the telephone or video conference. These codes apply to all patients including COVID-19.

Visit – 01000 series equivalents

Fee codeDescriptionRate
T13237Telehealth GP Visit (Age 0-1)$34.79
T13437Telehealth GP Visit (2-49)$31.62
T13537Telehealth GP Visit (age 50-59)$34.79
T13637Telehealth GP Visit (age 60-69)$36.36
T13737Telehealth GP Visit (age 70-79)$41.10
T13837Telehealth GP Visit (age 80+)$47.44

Please note: Submission of fee codes 13037 and 13017 with dates of service on or after June 1, 2020 will be rejected.

Counselling – 0120 series equivalents (minimum time per visit – 20 minutes)

Fee codeDescriptionRate
T13238Telehealth GP Individual Counselling for a prolong visit for counselling (age 0-1)$62.05
T13438Telehealth GP Individual Counselling for a prolong visit for counselling (age 2-49)$56.41
T13538Telehealth GP Individual Counselling for a prolong visit for counselling (age 50-59)$62.05
T13638Telehealth GP Individual Counselling for a prolong visit for counselling (age 60-69)$64.86
T13738Telehealth GP Individual Counselling for a prolong visit for counselling (age 70-79)$73.32
T13838Telehealth GP Individual Counselling for a prolong visit for counselling (age 80+)$84.60

Please note: Submission of fee codes 13038 and 13018 with dates of service on or after June 1, 2020 will be rejected.

Other notes:

  • MSP will pay up to four (4) individual counselling visits (any combination of age appropriate in office, out of office and Telehealth) per patient per year (see Preamble D. 3.3).
  • Start and end time must be entered into both the billing claims and patient’s chart.
  • Documentation of the effect(s) of the condition on the patient and what advice or service was provided is required.

Consultations – 0110 series equivalents

Fee CodeDescriptionRate
T13236Telehealth GP Consultation (age 0-1)$84.87
T13436Telehealth GP Consultation (age 2-49)$77.15
T13536Telehealth GP Consultation (age 50-59)$84.87
T13636Telehealth GP Consultation (age 60-69)$88.73
T13736Telehealth GP Consultation (age 70-79)$100.29
T13836Telehealth GP Consultation (age 80+)$115.75

Please note: Submission of fee codes 13036 and 13016 with dates of service on or after June 1, 2020 will be rejected.

Other Notes:

  • Non-procedural interventions provided by video or telephone where there is no Telehealth fee should be billed under the equivalent face-to-face fee with a claim note record stating the service was provided via Telehealth.
  • Some examples of non-procedural interventions provided by family physicians for which there is no Telehealth fee code include prenatal visits (14091); HIV primary care management (13015); OAT assessment and management of induction and maintenance of OAT (13013, 13014, 00039). Submission must include a claim note record stating the service was provided via Telehealth.

Things to keep in mind:

  • These new fees have the same value as the in-person fee codes for similar patient encounters.
  • These fee codes should be used regardless of the physician’s location (home, office or Health Authority approved facility).
  • Business Cost Premium (BCP) will apply to all codes.
  • Retro payments will not be made for dates of service prior to June 1, 2020.
  • From March 16 – May 31, 2020, the same telehealth fee codes for visits, counselling and consultations done by phone or video are to be used for patients, regardless of age.  (13037 and 13038 in most circumstances).  From June 1 onwards, use the new fee codes for phone and video services.
  • Any visit that you would have billed as a 0100 series or 0120 series when provided in-person should be billed as 13237 series or 13238 series.

We created a quick reference guide with the details on the MSP Telehealth codes. You can download it here.

5. Personal Health Risk Assessment and Chronic Disease Management Codes Now Available on Telehealth

On June 1, 2020, the Ministry announced that personal health risk assessment and chronic disease management services can now be done via Telehealth.

  • Personal Health Risk Assessment (Prevention) Fee
    The required face-to-face visit to provide a personal health risk assessment can now be provided via Telehealth. Physicians should include a note record when billing 14066 if the visit was provided to the patient via Telehealth.
  • Chronic Disease Management Fees
    Chronic Disease Management fees (14050, 14051, 14052 and 14053) may now be billed after one year of care if the two required visits were provided by Telehealth.

Notes:

  • 14029 is a $0 fee code that can be billed for a visit provided by a college-certified Allied Care Provider working within the family physician’s practice team.
  • Physicians submitting 14029 for services provided more than 90 days prior should submit such claims with submission code “A”.
  • Both of the two required visits may be a physician visit. Office, prenatal, home, long term care, or physician Telehealth visits qualify.
  • Alternatively, one of the two required visits must be a physician visit while the second visit may be:
    1. a telephone visit (14076) or
    2. a group medical visit (13763-13781) or
    3. an in-person visit with a college certified allied health provider (14029) working within the family physician’s practice.

If you are paid under an alternate payment/ funding model, the same change is true for the comparable Chronic Disease Management fees (14250, 14251, 14252, 14253).

We recognize the frequent changes and updates can be confusing and may result in missed billing opportunities and errors. We can help! Contact us to help you ensure you are billing the appropriate COVID-19, Virtual Care and Telehealth codes.

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