A920

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 534 / K4

Medical management of early pregnancy - initial service
    Medical management of early pregnancy - initial service when a physician renders an initial
    assessment and administration of cytotoxic medication(s) for the termination of early
    pregnancy or missed abortion. The cost of the drug(s) is not included in the fee for the service.
A920 Medical management of early pregnancy - initial service ........             193.70
    Payment rules:
    Services described as consultations, assessments or counselling (and those procedures that
    are generally accepted components of this service) are not eligible for payment when rendered
    the same day to the same patient by the same physician as A920.

PDF page 534 / K4

Medical management of ectopic pregnancy – initial service
    Medical Management of ectopic pregnancy – initial service when a physician renders an initial
    assessment and administration of cytotoxic medication(s) for the termination of an ectopic
    pregnancy. The cost of the drug(s) is not included in the fee for the service.
A922 Medical management of ectopic pregnancy - initial service ....               249.75
    Payment rules:
    Services described as consultations, assessments or counselling (and those procedures that
    are generally accepted components of this service) are not eligible for payment when rendered
    the same day to the same patient by the same physician as A922.
     [Commentary:
     As with all insured services, A920 and A922 must be provided in accordance with professional
     standards - such as those published by the Society of Obstetricians and Gynaecologists of
     Canada.]

PDF page 535 / K5

OBSTETRICS
 PRENATAL CARE
                                                                                                        Asst   Surg    Anae
       Medical management of early or ectopic pregnancy - follow-up visit
        Medical management of early or ectopic pregnancy - follow-up visit is for a visit that is a follow-
        up of A920 or A922, whether rendered by the same physician who rendered the A920 or A922
        service or by another physician.
   A921 Medical management of early or ectopic pregnancy - follow-up
          visit .....................................................................................          44.55
         Payment rules:
         1.Services described as consultations, assessments or counselling (and those procedures that
           are generally accepted components of this service) are not eligible for payment when
           rendered the same day to the same patient by the same physician as A921.
         2.A921 is limited to two per patient per pregnancy. Services in excess of this limit will be
           adjusted to another assessment fee.
   P001 Medical management of non-viable fetus or intra-uterine fetal
           demise between 14 and 20 weeks gestation .....................              479.55
       Payment rules:
       1.P001 is only eligible for payment if the length of gestation is confirmed by ultrasound.
         2.Services described as consultations, assessments or counselling (and those procedures that
           are generally accepted components of this service, including cervical ripening and oxytocin
           infusion if rendered) are not eligible for payment when rendered the same day to the same
           patient by the same physician as P001.
         3.Z774 is eligible for payment in addition to P001 if uterine curettage is required for postpartum
           hemorrhage due to retained products.
         [Commentary:
         P001 is only payable for the active medical management of the patient. It is not payable when
         the fetus delivers spontaneously prior to initiating intervention.]

Master, record 324. Record Layout PDF, page 1.

A92020260401999999990000193700000000000000000000000000000000000000000000000

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.