A947

PDF page 78 / GP64

2. Despite any other provision in this Schedule, the amount payable for the following services to
     an insured person who is at least 65 years of age, as those services are defined in this
     Schedule, is increased by 15 per cent:
     a. A general assessment (A003, C003, W102, or W109);
     b. A general re-assessment (A004, C004, W004);
     c. An intermediate assessment (A007);
     d. A focused practice assessment (A917, A927, A937, A947, A957 or A967);
     e. A periodic health visit (K132).
     f. Comprehensive assessment and care (H102, H122, H132, H152)
     g. A multiple systems assessment (H103, H123, H133, H153)

PDF page 137 / A9

CONSULTATIONS AND VISITS
      FAMILY PRACTICE & PRACTICE IN GENERAL (00)
                                          Payment rules:
                                          1.K133 is limited to one per patient per 12 month period.
                                          2.Only one of K133, K131, or K132 is eligible for payment per patient per physician per 12
                                            month period.
                                          3.This service can be provided over multiple distinct time periods, however, a minimum of 50
                                            minutes total time spent in direct contact with the patient is required, exclusive of time spent
                                            rendering any other separately billable intervention to the patient. Start and stop times must
                                            be recorded for each time period related to the service. For payment purposes, the service
                                            date on the claim must be the date on which all requirements for the service have been
                                            completed. No other services are eligible for payment for time periods used to meet the time
                                            requirements of this service.
                                          4.While some aspects of K133 may be provided virtually, a minimum of 26 minutes must be
                                            provided through direct physical encounter(s).
                                          5.K133 is only payable when the patient has one of the following conditions (listed with ministry
                                            diagnostic codes):
                                              a.Autism spectrum disorder (299)
                                              b.Intellectual disability or Fetal Alcohol Syndrome (319)
                                              c.Cerebral palsy (343)
                                              d.Spina bifida, with or without hydrocephalus, meningocele, meningomyelocele (741)
                                              e.Chromosomal anomalies such as Down’s syndrome, Fragile X syndrome, other
                                                autosomal anomalies (758)
                                          Claims submission instructions:
                                          A diagnostic code listed above that corresponds to the patient’s condition must accompany the
                                          claim for payment purposes.
                                          [Commentary:
                                          1.Guidelines relating to coordinated care and management plans can be found at: https://
                                            www.cfp.ca/content/cfp/64/4/254.full.pdf
                                          2.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 periodic
                                            health visit and (2) non-patient-facing time such as such as time spent reviewing charts,
                                            imaging, or documentation, etc.]
                                   Focused practice assessment (FPA)
                                    FPA is an assessment rendered by a GP/FP physician, unless otherwise specified, with
                                    additional training and/or experience in sport medicine, allergy, pain management, sleep
                                    medicine, addiction medicine (including methadone) or care of the elderly (age 65 or older).
                                    The assessment must satisfy, at a minimum, all of the requirements of an intermediate
                                    assessment.
               A917 Sport medicine FPA ................................................................                    44.55
               A927 Allergy FPA .............................................................................              44.55
               A937 Pain management FPA...........................................................                         44.55
               A947 Sleep medicine FPA................................................................                     44.55
               A957 Addiction medicine FPA..........................................................                       44.55
               A967 Care of the elderly FPA...........................................................                     44.55

PDF page 138 / A10

CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
      Payment rules:
      1.No other consultation, assessment, visit or counselling service is eligible for payment when
        rendered the same day as one of A917, A927, A937, A947, A957 or A967 to the same patient
        by the same physician.
      2.E079 is not eligible for payment with any FPA.
      3.A957 may also be billed by a specialist with additional training and/or experience in addiction
        medicine (including methadone).
      [Commentary:
      Physicians should be prepared to provide to the ministry documentation demonstrating training
      and/or experience on request.]

Master, record 335. Record Layout PDF, page 1.

A94720260401999999990000044550000000000000000000000000000000000000000000000

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.