A814

PDF page 78 / GP64

GENERAL PREAMBLE
AGE-BASED FEE PREMIUMS
 1. Despite any other provision in this Schedule, the amount payable for the following services to
    an insured person who falls into the age group described in the Age Group column of the
    following Age Premium Table is increased by the percentage specified in Percentage Increase
    column opposite the Age Group:
    a. A consultation, limited consultation or repeat consultation rendered by a specialist, as those
        services are defined in this Schedule.
     b. A surgical procedure listed in Parts K to Z inclusive of this Schedule.
     c. Basic and time unit surgical assistant services listed in Parts K to Z inclusive of this
        Schedule.
     d. Clinical Procedures associated with Diagnostic Radiological Examinations.
     e. A specific assessment or a partial assessment rendered by a specialist in ophthalmology
        (23) (A233 or A234).
     f. A Midwife or Aboriginal Midwife-Requested Special Assessment (A815, C815 or A817) or a
        Midwife or Aboriginal Midwife-Requested Assessment (A813, C813 or A814) rendered by a
        specialist.

PDF page 194 / A66

CONSULTATIONS AND VISITS
VIRTUAL CARE SERVICES
   DEFINITIONS:
    For the purposes of this section of the Schedule only, the following Definitions apply:
     Comprehensive Virtual Care Service means a Virtual Care Service rendered where an
     Existing/Ongoing Patient-Physician Relationship exists, and in the physicians’ professional
     opinion in accordance with accepted professional standards and practice, the person's care
     and support requirements can be effectively and appropriately delivered by Video or
     Telephone.
     Existing/Ongoing Patient-Physician Relationship means:
 1. Where a physician is providing a Virtual Care Service to a patient where there has been at least
    one insured service with a direct physical encounter between the patient and that physician
    (Family and General Practice Physician or specialist) in the preceding 24-months; or
 2. Where a physician is providing a Virtual Care Service to a patient who has signed the MOH’s
    Patient Enrollment and Consent to Release Personal Health Information form and is enrolled to
    that physician or another physician within the same group (who is signatory/locum to a MOH
    alternate funding plan agreement); or
 3. Where a specialist or GP Focused Practice Physician is providing a consultation by Video set
    out in Appendix J – Section 1, or has provided any such consultation in the preceding 24-
    months to that patient; or
     [Commentary:
     Where the visit leading to the referral for consultation has occurred virtually, it would be
     expected that the referring physician has an established relationship with the patient and that
     the clinical issue leading to the referral has been assessed in-person within the previous 12-
     months.]
     [Commentary:
     Where a physician who has been paid for a consultation for the patient for the same diagnosis
     makes a request for a referral for ongoing management of the patient, the service rendered
     following the referral is not payable as a consultation, unless the request for referral, if the
     referral is made, allows for an ongoing patient physician relationship in the context of a
     consultation by Video.]
 4. Where a physician provides any of the following services, or has provided any of the following
    services in the preceding 24-months:
            •   A920 – Medical management of early pregnancy - initial service by Video or
                Telephone,
            •   A945/C945 – Special palliative care consultation by Video,
            •   A320/C320 - Special Medical Assistance in Dying (MAID) consultation by Video,
            •   A680/C680 – Initial assessment - substance abuse by Video,
            •   A814, A817, A818 – Midwife or Aboriginal Midwife-Requested Assessments
                (MRAs) by Video,
            •   A802 – Extended midwife or Aboriginal Midwife-requested genetic assessment by
                Video,

PDF page 198 / A70

Comprehensive Virtual Care Services – Virtual Only Fee Codes
   Midwife or Aboriginal Midwife-Requested Assessment (MAMRA) by Video
    Midwife or Aboriginal Midwife-Requested Assessment (MAMRA) by Video is an assessment of
    a mother or newborn provided by a physician upon the written request of a midwife or
    Aboriginal Midwife because of the complex, obscure or serious nature of the patient’s problem
    and is payable to a family physician or obstetrician for such an assessment in any setting.
     Urgent or emergency requests may be initiated verbally but must subsequently be requested in
     writing. The written request must be retained on the patient’s permanent medical record. The
     MRA must include the common and specific elements of a specific assessment by Video and
     the physician must submit his/her findings, opinions and recommendations verbally to the
     midwife or Aboriginal Midwife, and in writing to both the midwife or Aboriginal Midwife and the
     patient’s primary care physician or nurse practitioner, if applicable. Maximum one MAMRA
     (A814 or A813) per patient per physician per pregnancy.
 A814 Midwife or Aboriginal Midwife-Requested Assessment
           (MAMRA) by Video............................................................. 111.70

PDF page 199 / A71

Midwife or Aboriginal Midwife-Requested Special Assessment (MAMRSA) by Video
          Midwife or Aboriginal Midwife-Requested Special Assessment (MAMRSA) by Video must
          include constituent elements of A814 and is payable in any setting:
         a. to a paediatrician for an urgent or emergency assessment of a newborn; or
         b. to a family physician or obstetrician for assessment of a mother or newborn when, because
            of the very complex, obscure or serious nature of the problem, the physician must spend at
            least 50 minutes in direct contact with the patient, exclusive of time spent rendering any
            other separately billable intervention to the patient. The start and stop times of the
            assessment must be recorded on the patient’s permanent medical record. In the absence of
            such information, the service is payable as A814. Maximum one MAMRSA (A817 or A815)
            per patient per physician per pregnancy.
   A817 Midwife or Aboriginal Midwife-Requested Special Assessment
            (MAMRSA) by Video .......................................................... 186.95
       [Commentary:
       Unless otherwise specified in the Schedule, the calculation of time excludes (1) time devoted to
       any other service or procedure for which an amount is payable in addition to the assessment
       and (2) non-patient-facing time such as such as time spent reviewing charts, imaging, or
       documentation, etc.]

PDF page 826 / AJ2

APPENDIX J
VIDEO ONLY
     A010A, A011A, A015A, A016A, A021A, A025A, A026A, A035A, A036A,
     A045A, A046A, A050A, A055A, A056A, A065A, A066A, A075A, A076A,
     A085A, A086A, A095A, A096A, A116A, A130A, A135A, A136A, A150A,
     A155A, A156A, A160A, A165A, A166A, A175A, A176A, A180A, A185A,
     A186A, A190A, A191A, A192A, A195A, A196A, A197A, A198A, A205A,
     A206A, A210A, A220A, A223A, A225A, A226A, A235A, A236A, A245A,
     A246A, A253A, A255A, A256A, A260A, A265A, A266A, A275A, A285A,
     A286A, A315A, A316A, A320A, A325A, A335A, A345A, A346A, A355A,
     A356A, A365A, A375A, A385A, A395A, A400A, A405A, A415A, A416A,
     A425A, A435A, A445A, A446A, A460A, A465A, A466A, A470A, A475A,
     A476A, A485A, A486A, A515A, A525A, A545A, A565A, A575A, A580A,
     A586A, A590A, A595A, A600A, A605A, A606A, A615A, A616A, A625A,
     A626A, A635A, A636A, A645A, A646A, A655A, A662A, A665A, A667A,
     A675A, A680A, A682A, A695A, A710A, A715A, A720A, A725A, A726A,
     A735A, A745A, A770A, A775A, A795A, A800A, A801A, A802A, A814A,
     A817A, A818A, A835A, A845A, A865A, A906A, A913A, A914A, A915A,
     A925A, A935A, A945A, C010A, C013A, C014A, C015A, C016A,
     C020A, C023A, C024A, C025A, C026A, C033A, C034A, C035A, C036A,
     C043A, C044A, C045A, C046A, C051A, C053A, C054A, C055A, C063A,
     C064A, C065A, C066A, C071A, C073A, C074A, C075A, C076A, C083A,
     C084A, C085A, C086A, C093A, C094A, C095A, C096A, C111A, C113A,
     C114A, C116A, C130A, C131A, C133A, C134A, C135A, C136A, C150A,
     C151A, C153A, C154A, C155A, C156A, C160A, C161A, C163A, C164A,
     C165A, C166A, C173A, C174A, C175A, C176A, C180A, C181A, C183A,
     C184A, C185A, C186A, C190A, C193A, C194A, C196A, C203A, C204A,
     C205A, C206A, C210A, C220A, C223A, C225A, C226A, C233A, C234A,
     C235A, C236A, C243A, C244A, C245A, C246A, C255A, C260A, C263A,
     C264A, C265A, C266A, C270A, C275A, C283A, C285A, C286A, C311A,
     C313A, C314A, C315A, C316A, C320A, C325A, C335A, C341A, C343A,
     C344A, C345A, C346A, C353A, C354A, C355A, C356A, C365A, C375A,
     C385A, C395A, C411A, C413A, C414A, C415A, C416A, C425A, C435A,
     C441A, C443A, C444A, C445A, C446A, C460A, C461A, C463A, C464A,
     C465A, C466A, C470A, C471A, C473A, C474A, C475A, C476A, C480A,
     C481A, C483A, C484A, C485A, C486A, C510A, C511A, C515A, C545A,
     C565A, C570A, C575A, C580A, C585A, C586A, C590A, C595A, C600A,
     C601A, C603A, C604A, C605A, C606A, C611A, C613A, C614A, C615A,
     C616A, C623A, C624A, C625A, C626A, C635A, C643A, C644A, C645A,
     C646A, C655A, C661A, C662A, C665A, C667A, C675A, C680A, C682A,
     C695A, C720A, C721A, C723A, C724A, C725A, C726A, C710A, C713A,
     C715A, C735A, C745A, C760A, C770A, C775A, C795A, C845A, C865A,
     C895A, C915A, C925A, C935A, C945A, K630A, W025A, W026A,
     W075A, W076A, W130A, W150A, W155A, W156A, W165A, W185A,
     W190A, W196A, W235A, W236A, W275A, W310A, W355A, W356A,
     W375A, W395A, W425A, W435A, W465A, W466A, W510A, W511A,
     W515A, W516A, W535A, W720A, W725A, W726A, W770A, W775A,
     W795A, W895A, W925A

Master, record 300. Record Layout PDF, page 1.

A81420250601999999990000111700000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.