Fee
| Component | Value |
|---|---|
| Fee basis | 50% |
| Source listing ; PDF p. 202 | 50% |
| Source listing ; PDF p. 211 | 50% |
| Source listing ; PDF p. 226 | 50% |
| Source listing ; PDF p. 248 | 50% |
| Source listing ; PDF p. 251 | 50% |
| Source listing ; PDF p. 253 | 50% |
| Source listing ; PDF p. 260 | 50% |
| Source listing ; PDF p. 262 | 50% |
| Source listing ; PDF p. 268 | 50% |
| Source listing ; PDF p. 298 | 50% |
| Source listing ; PDF p. 303 | 50% |
| Source listing ; PDF p. 323 | 50% |
| Source listing ; PDF p. 325 | 50% |
| Source listing ; PDF p. 328 | 50% |
Schedule and sources
- Fee edition
- October 1, 2026
- Record effective
- 2023-01-01
- Schedule edition
- July 22, 2026; effective July 1, 2026
- Official files
- Fee masterSchedule PDFOntario source page
Chronic Disease Assessment 50% of fee for virtual service
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
- chronic disease assessment premium (see General Preamble GP25) ................................................ add 50%
Passages mentioning E078
GENERAL LISTINGS
A625 Consultation............................................................................ 160.30
A525 Limited consultation ................................................................ 105.25
A626 Repeat consultation ................................................................ 105.25
A623 Medical specific assessment .................................................. 95.95
A624 Medical specific re-assessment.............................................. 72.00
A621 Complex medical specific re-assessment............................... 83.40
A628 Partial assessment ................................................................. 44.75
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%CONSULTATIONS AND VISITS
ENDOCRINOLOGY & METABOLISM (15)
GENERAL LISTINGS
A155 Consultation............................................................................ 172.95
Comprehensive endocrinology consultation
This service is a consultation rendered by a specialist in endocrinology who provides all the
appropriate elements of a consultation and spends a minimum of seventy-five (75) minutes in
direct contact with the patient, exclusive of time spent rendering any other separately billable
intervention to the patient.
A150 Comprehensive endocrinology consultation ........................... 342.25
Medical record requirements:
The start and stop times must be recorded in the patient’s permanent medical record or the
amount payable for the service will be adjusted to a lesser paying fee.
[Commentary:
1.A150 must satisfy all the elements of a consultation (see page GP16).
2.Unless otherwise specified in the Schedule, the calculation of the 75 minute minimum time
for comprehensive endocrinology consultations excludes (1) time devoted to any other
service or procedure for which an amount is payable in addition to the consultation and (2)
non-patient-facing time such as such as time spent reviewing charts, imaging, or
documentation, etc.]
A255 Limited consultation ................................................................ 110.15
A156 Repeat consultation ................................................................ 110.15
A153 Medical specific assessment .................................................. 95.95
A154 Medical specific re-assessment.............................................. 72.00
A151 Complex medical specific re-assessment............................... 83.40
A158 Partial assessment ................................................................. 44.75
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%
Complex endocrine neoplastic disease assessment
This service is an assessment in relation to one or more of the following diseases where the
complexity of the condition requires the ongoing management by an endocrinologist:
a.thyroid neoplasm;
b.parathyroid neoplasm;
c.pituitary neoplasm; or
d.adrenal neoplasm.
A760 Complex endocrine neoplastic disease assessment .............. 102.95
Payment rules:
1.A760 must include the elements of a medical specific re-assessment, or the amount payable
will be adjusted to a lesser assessment fee.
2.A760 is limited to 6 per patient, per physician, per 12 month period and up to 12 per patient
per physician for 24 consecutive months. Services in excess of this limit will be adjusted to a
lesser assessment fee.
3.E078 is not eligible for payment with A760.
[Commentary:
A760 is not payable for the evaluation and/or management of uncomplicated endocrine
disorders.]CONSULTATIONS AND VISITS
GERIATRICS (07)
A375 Limited consultation ................................................................ 113.35
A076 Repeat consultation ................................................................ 113.35
A073 Medical specific assessment .................................................. 99.05
A074 Medical specific re-assessment.............................................. 79.85
A071 Complex medical specific re-assessment............................... 103.80
A078 Partial assessment ................................................................. 49.65
Payment rules:
A073, A074, A071 and A078 are only eligible for payment for a patient at least 65 years of age
or when the assessment is for the assessment of dementia.
[Commentary:
A073, A074, A071 and A078 are eligible for payment when the consultation is for the
assessment of dementia regardless of the patient's age.]
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%
Geriatric telephone support
This is the service initiated by a caregiver where a physician provides telephone support to a
caregiver(s) for a patient with an established diagnosis of dementia.
K077 Geriatric telephone support ........................................ per unit 43.10
Payment rules:
1.A maximum of two (2) units of K077 are eligible for payment per patient per day.
2.A maximum of twelve(12) K077 units are eligible for payment per patient per 12 month
period.
3.K077 is only eligible for payment where:
a.there is a minimum of 10 minutes of patient-related discussion; and
b.the physician:
i. is a specialist in Geriatrics (07); or
ii. has a certificate of special competence in Geriatrics; or
iii. has an exemption to access bonus impact in Care of the Elderly from the MOH.
4.In circumstances where a physician receives compensation, other than by fee-for-service
under this Schedule, for the provision of telephone support for caregivers, this service is not
eligible for payment to that physician.
[Commentary:
1.Payment, other than by fee-for-service includes compensation where the physician receives
remuneration under a salary, primary care, stipend, APP or AFP model.
2.Physicians who receive compensation other than by fee-for-service under this Schedule
should consult their contract for guidance on shadow-billing.]
Medical record requirements:
K077 is only eligible for payment where the following elements are included in the medical
record:
1.patient’s name and health number;
2.start and stop times of the discussion;
3.reason for the telephone support; and
4.the opinion, advice and/or recommendations of the physician.CONSULTATIONS AND VISITS
HAEMATOLOGY (61)
For Services not listed, refer to Internal Medicine Section.
GENERAL LISTINGS
A615 Consultation............................................................................ 192.90
A655 Limited consultation ................................................................ 118.05
A616 Repeat consultation ................................................................ 118.05
A613 Medical specific assessment .................................................. 95.95
A614 Medical specific re-assessment.............................................. 72.00
A611 Complex medical specific re-assessment............................... 83.40
A618 Partial assessment ................................................................. 44.75
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%
EMERGENCY OR OUT-PATIENT DEPARTMENT (OPD)
Physician in hospital but not on duty in the Emergency Department when seeing patients in the
Emergency or OPD - use General Listings.
NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES
See General Preamble GP40 to GP48. For emergency calls and other special visits to in-
patients, use General Listings and Premiums when applicable - see General Preamble GP65
to GP78.
C615 Consultation............................................................................ 192.90
C655 Limited consultation ................................................................ 118.05
C616 Repeat consultation ................................................................ 118.05
C613 Medical specific assessment .................................................. 95.95
C614 Medical specific re-assessment.............................................. 72.00
C611 Complex medical specific re-assessment............................... 83.40
Subsequent visits
C612 - first five weeks........................................................ per visit 40.05
C617 - sixth to thirteenth week inclusive (maximum 3 per patient
per week)................................................................ per visit 40.05
C619 - after thirteenth week (maximum 6 per patient per month)
............................................................................... per visit 40.05
Subsequent visits by the Most Responsible Physician (MRP)
See General Preamble GP44 to GP45 for terms and conditions.
C122 - day following the hospital admission assessment.............. 71.80
C123 - second day following the hospital assessment .................. 71.80
C124 - day of discharge ................................................................. 71.80
C126 - day of discharge, medically complex patient (see A13 for
terms and conditions) ......................................................... 95.10
Subsequent visits by the MRP following transfer from an Intensive Care Area
See General Preamble GP46 for terms and conditions.
C142 - first subsequent visit by the MRP following transfer from an
Intensive Care Area............................................................ 71.80CONSULTATIONS AND VISITS
INFECTIOUS DISEASE (46)
GENERAL LISTINGS
A465 Consultation............................................................................ 205.90
Comprehensive infectious disease consultation
This service is a consultation rendered by a specialist in infectious disease who provides all the
appropriate elements of a consultation and spends a minimum of 75 minutes in direct contact
with the patient exclusive of time spent rendering any other separately billable intervention to
the patient.
A460 Comprehensive infectious disease consultation..................... 342.25
Medical record requirements:
The start and stop times must be recorded in the patient’s permanent medical record or the
amount payable for the service will be adjusted to a lesser paying fee.
[Commentary:
1.A460 must satisfy all the elements of a consultation (see page GP16).
2.Unless otherwise specified in the Schedule, the calculation of the 75 minute minimum time
for comprehensive infectious disease consultations excludes (1) time devoted to any other
service or procedure for which an amount is payable in addition to the consultation and (2)
non-patient-facing time such as such as time spent reviewing charts, imaging, or
documentation, etc.]
A275 Limited consultation ................................................................ 119.30
A466 Repeat consultation ................................................................ 124.00
A463 Medical specific assessment .................................................. 107.00
A464 Medical specific re-assessment.............................................. 82.10
A461 Complex medical specific re-assessment............................... 95.05
A468 Partial assessment ................................................................. 62.15
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%
Complex Infectious Disease Assessment
This service is an assessment for the ongoing management of any of the following infectious diseases
where the complexity of the condition requires the continuing management by an infectious disease
specialist and where the visit requires a minimum of 20 minutes in direct contact with the patient,
exclusive of time spent rendering any other separately billable intervention to the patient:
a. active pulmonary or extrapulmonary disease due to mycobacterial tuberculosis complex
(latent tuberculosis infection is excluded); or
b. active pulmonary or extrapulmonary non-tuberculous mycobacterial disease (airway or
tissue colonization without disease is excluded)
c. Deep seeded fungal infection (aspergilloma is excluded) - e.g.: dimorphic fungi, candida
auris infections
d. Patient with an infection with a multi drug resistant organism (e.g. MDR pseudomonas,
ESBL, AmpC, CPE, MRSA, VRE) who are currently requiring IV antibiotic (or PO linezolid),
outside of hospital, supervised by the physician.
A270 Complex infectious disease assessment................................ 95.05GENERAL LISTINGS
A285 Consultation............................................................................ 163.00
A286 Limited consultation ................................................................ 108.95
A586 Repeat consultation ................................................................ 110.00
A283 Medical specific assessment .................................................. 82.50
A284 Partial assessment ................................................................. 38.85
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%CONSULTATIONS AND VISITS
MEDICAL ONCOLOGY (44)
GENERAL LISTINGS
A445 Consultation............................................................................ 183.40
A845 Limited consultation ................................................................ 115.95
A446 Repeat consultation ................................................................ 115.95
A443 Medical specific assessment .................................................. 95.95
A444 Medical specific re-assessment.............................................. 72.00
A441 Complex medical specific re-assessment............................... 83.40
A448 Partial assessment ................................................................. 44.75
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%
EMERGENCY OR OUT-PATIENT DEPARTMENT (OPD)
Physician in hospital but not on duty in the Emergency Department when seeing patients in the
Emergency or OPD - use General Listings.
NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES
See General Preamble GP40 to GP48. For emergency calls and other special visits to
in-patients, use General Listings and Premiums when applicable - see General Preamble
GP65 to GP78.
C445 Consultation............................................................................ 183.40
C845 Limited consultation ................................................................ 115.95
C446 Repeat consultation ................................................................ 115.95
C443 Medical specific assessment .................................................. 95.95
C444 Medical specific re-assessment.............................................. 72.00
C441 Complex medical specific re-assessment............................... 83.40
Subsequent visits
C442 - first five weeks ....................................................... per visit 40.05
C447 - sixth to thirteenth week inclusive (maximum 3 per patient
per week)................................................................ per visit 40.05
C449 - after thirteenth week (maximum 6 per patient per month)
.............................................................................. per visit 40.05
Subsequent visits by the Most Responsible Physician (MRP)
See General Preamble GP44 to GP45 for terms and conditions.
C122 - day following the hospital admission assessment.............. 71.80
C123 - second day following the hospital assessment .................. 71.80
C124 - day of discharge ................................................................. 71.80
C126 - day of discharge, medically complex patient (see A13 for
terms and conditions) ......................................................... 95.10Extended special neurology consultation
Extended special neurology consultation is a consultation in which the physician provides all
the elements of a consultation (A185) and spends a minimum of 90 minutes in direct contact
with the patient, exclusive of time spent rendering any other separately billable intervention to
the patient.
A682 Extended special neurology consultation ............................... 442.40
Medical record requirements:
The service is only eligible for payment if start and stop times of the service are recorded in the
patient's permanent medical record.
[Commentary:
Unless otherwise specified in the Schedule, the calculation of time for A180 and A682 excludes
(1) time devoted to any other service or procedure for which an amount is payable in addition to
the consultation and (2) non-patient-facing time such as such as time spent reviewing charts,
imaging, or documentation, etc.]
A385 Limited consultation ................................................................ 125.50
A186 Repeat consultation ................................................................ 125.50
A183 Medical specific assessment .................................................. 82.40
A184 Medical specific re-assessment.............................................. 64.95
A181 Complex medical specific re-assessment............................... 75.20
A188 Partial assessment ................................................................. 39.40
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%
Dose titration and programming of external infusion pump for the treatment of advanced
Parkinson's disease
Dose titration and programming of external infusion pump for the treatment of advanced
Parkinson's disease is a time based all-inclusive service for the purpose of providing
assessment and dose optimization for a patient with advanced Parkinson's disease receiving
continuous subcutaneous or enteral infusion. This service is claimed in units - unit means ½
hour or major part thereof - see the General Preamble GP7, GP55 for definitions and time
keeping requirements.
K180 Dose titration and programming of external infusion pump for
the treatment of advanced Parkinson's disease..... per unit 125.00CONSULTATIONS AND VISITS
NEUROLOGY (18)
3. the following neuro-oncology conditions:
a. primary tumor of the central nervous system;
b. central nervous system metastasis;
c. neurological complications of cancer therapy;
d. paraneoplastic neurological syndromes.
A113 Complex neurological assessment ......................................... 120.00
Payment rules:
1.A complex neurological assessment must include the elements of a medical specific re-
assessment, or the amount payable will be adjusted to lesser assessment fee.
2.This service is not eligible for payment to a physician for the initial evaluation of the patient by
that physician.
3.Complex neurological assessments are limited to 6 per patient, per physician, per 12 month
period. Services in excess of this limit will be adjusted to a lesser assessment fee.
4.This service is not eligible for payment unless the patient has an established diagnosis of a
chronic complex neurological disease, documented in the patient’s medical record.
5.E078 is not eligible for payment with A113.
Medical record requirements:
The start and stop times must be recorded in the patient’s permanent medical record or the
amount payable for the service will be adjusted to a lesser paying fee.
[Commentary:
1.A complex neurological assessment is for the ongoing management of complex neurological
disorders, where the complexity of the condition requires the continuing management by a
neurologist. It is not intended for the evaluation and/or management of uncomplicated
neurological disorders (e.g. carpal tunnel syndrome, Bell’s palsy, asymptomatic diabetic
neuropathy).
2.A consultation or assessment service, as appropriate, may be claimed for the initial
evaluation of a patient. A complex neurological assessment is for the ongoing management
of a patient with a complex neurological disorder.]
Consultation and Management for Acute Cerebral Vascular Syndrome (ACVS)
A Consultation and Management for ACVS is a service in which the physician provides all the
elements of a consultation (A185) to a patient referred for suspected ACVS and, if necessary,
treatment with intravenous thrombolysis therapy and post-administration monitoring.
A384 ................................................................................................ 275.95
K181 - after first 30 minutes, must include intravenous thrombolysis
therapy and monitoring, per 30 minute unit (or major part
thereof) ............................................................................... 90.00
Medical record requirements:
Consultation and Management for ACVS is only eligible for payment if start and stop times of
the services and the time of onset of symptoms are recorded in the patient's permanent
medical record.CONSULTATIONS AND VISITS
PAEDIATRICS (26)
Prenatal consultation
A prenatal consultation is the service rendered by a paediatrician upon request of a physician
or nurse practitioner who considers a fetus of greater than 20 weeks gestation to be at risk or in
jeopardy by reason of continuation of pregnancy in the presence of maternal and/or fetal
distress.
[Commentary:
A prenatal consultation by a paediatrician does not preclude the paediatrician from claiming a
post-natal consultation on the infant.]
A665 Prenatal consultation .............................................................. 105.50
A565 Limited consultation ................................................................ 104.70
A266 Repeat consultation ................................................................ 104.70
A263 Medical specific assessment .................................................. 95.75
A264 Medical specific re-assessment.............................................. 70.75
A661 Complex medical specific re-assessment............................... 86.35
A268 Enhanced 18 month well baby visit (see General Preamble
GP34) ................................................................................. 74.25
A261 Level 1 - Paediatric assessment............................................. 24.85
A262 Level 2 - Paediatric assessment............................................. 50.20
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%
K045 Diabetes management by a specialist .................................... 80.25
[Commentary:
For K045 definition/required elements, payment rules, and record keeping requirements, see
Endocrinology and Metabolism section.]
Periodic health visit
K267 - 2 - 11 years of age.............................................................. 48.05
K269 - 12 - 17 years of age ........................................................... 89.15
Note:
1.For definitions and payment rules - see General Preamble GP21.
2.Diagnostic interview and/or counselling with child and/or parent - see listings in Family
Practice & Practice in General.
Paediatric Developmental Assessment Incentive (PDAI)
PDAI is the service rendered by a paediatrician most responsible for providing ongoing
management of a paediatric patient at developmental risk. The service is for ongoing
management using a developmental surveillance approach and documenting the indicators of
the child’s development three times in a 12 month period.
K119 Paediatric developmental assessment incentive .................... 142.50
Payment rules:
1.K119 is limited to a maximum of one service per patient per 12 month period.
2.K119 is limited to a maximum of six services per patient per lifetime.
3.K119 is only eligible for payment for a service rendered to a person under six years of age.CONSULTATIONS AND VISITS
PHYSICAL MEDICINE & REHABILITATION (31)
GENERAL LISTINGS
A315 Consultation............................................................................ 220.80
Comprehensive physical medicine and rehabilitation consultation
A comprehensive physical medicine and rehabilitation consultation is a consultation in which
the physician provides all the elements of a consultation and spends a minimum of 75 minutes
in direct contact with the patient, exclusive of time spent rendering any other separately billable
intervention to the patient.
A425 Comprehensive physical medicine and rehabilitation
consultation ........................................................................ 342.25
Payment rules:
A comprehensive physical medicine and rehabilitation consultation is limited to one every 2
years by the same physician.
Medical record requirements:
The start and stop time must be recorded in the patient’s permanent medical record or the
payment for the service will be reduced to a lesser fee.
[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 consultation
and (2) non-patient-facing time such as such as time spent reviewing charts, imaging, or
documentation, etc.]
A515 Limited consultation ................................................................ 106.60
A316 Repeat consultation ................................................................ 106.60
A313 Medical specific assessment .................................................. 86.40
A310 Medical specific re-assessment.............................................. 75.90
A311 Complex medical specific re-assessment............................... 82.75
A318 Partial assessment ................................................................. 44.45
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%CONSULTATIONS AND VISITS
PHYSICAL MEDICINE & REHABILITATION (31)
Complex neuromuscular assessment
A complex neuromuscular assessment is an assessment for the ongoing management of the
following diseases of the neuromuscular system where the complexity of the condition requires
the continuing management by a physical medicine and rehabilitation specialist:
a.generalized peripheral neuropathies;
b.myopathies;
c.diseases of the neuromuscular junction; or
d.diseases of the motor neurone
A510 Complex neuromuscular assessment..................................... 104.85
Payment rules:
1.A complex neuromuscular assessment must include the elements of a medical specific re-
assessment, or the amount payable will be adjusted to lesser assessment fee.
2.This service is not eligible for payment to a physician for the initial evaluation of the patient by
that physician.
3.Complex neuromuscular assessments are limited to 6 per patient, per physician, per 12
month period.
Services in excess of this limit will be adjusted to a lesser assessment fee.
4.E078 is not eligible for payment with A510.
[Commentary:
1. A complex neuromuscular assessment is for the ongoing management of complex
neuromuscular disorders, where the complexity of the condition requires the continuing
management by a physical medicine and rehabilitation specialist. It is not intended for the
evaluation and/or management of uncomplicated neuromuscular disorders (e.g. carpal
tunnel syndrome, Bell’s palsy, asymptomatic diabetic neuropathy).
2.A consultation or assessment service, as appropriate, may be claimed for the initial
evaluation of a patient. A complex neuromuscular assessment is for the ongoing
management of a patient with a complex neuromuscular disorder.]
Complex physiatry assessment
This service is an assessment in relation to the following diseases where the complexity of the
condition requires the ongoing management by a physical medicine and rehabilitation
specialist:
a. traumatic brain injury;
b. stroke (hemorrhagic and ischemic); or
c. spinal cord injury.
A511 Complex physiatry assessment .............................................. 114.80
Payment rules:
1.A complex physiatry assessment must include the elements of a medical specific re-
assessment, or the amount payable will be adjusted to a lesser assessment fee.
2.Complex physiatry assessments are limited to 6 per patient, per physician, per 12 month
period.
Services in excess of this limit will be adjusted to a lesser assessment fee.
3.E078 is not eligible for payment with A511.CONSULTATIONS AND VISITS
RADIATION ONCOLOGY (34)
GENERAL LISTINGS
A345 Consultation............................................................................ 178.75
A745 Limited consultation ................................................................ 114.90
A346 Repeat consultation ................................................................ 114.90
A343 Medical specific assessment .................................................. 95.95
A340 Medical specific re-assessment.............................................. 72.00
A341 Complex medical specific re-assessment............................... 83.40
A348 Partial assessment ................................................................. 44.75
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%
EMERGENCY OR OUT-PATIENT DEPARTMENT (OPD)
Physician in hospital but not on duty in the Emergency Department when seeing patient(s) in
the Emergency or OPD - use General Listings.
NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES
See General Preamble GP40 to GP48. For emergency calls and other special visits to in-
patients, use General Listings and Premiums when applicable - see General Preamble GP65
to GP78.
C345 Consultation............................................................................ 178.75
C745 Limited consultation ................................................................ 114.90
C346 Repeat consultation ................................................................ 114.90
C343 Medical specific assessment .................................................. 95.95
C344 Medical specific re-assessment.............................................. 72.00
C341 Complex medical specific re-assessment............................... 83.40
Subsequent visits
C342 - first five weeks........................................................ per visit 40.05
C347 - sixth to thirteenth week inclusive (maximum 3 per patient
per week)................................................................ per visit 40.05
C349 - after thirteenth week (maximum 6 per patient per month)
............................................................................... per visit 40.05
Subsequent visits by the Most Responsible Physician (MRP)
See General Preamble GP44 to GP45 for terms and conditions.
C122 - day following the hospital admission assessment.............. 71.80
C123 - second day following the hospital assessment .................. 71.80
C124 - day of discharge ................................................................. 71.80
C126 - day of discharge, medically complex patient (see A13 for
terms and conditions) ......................................................... 95.10
Subsequent visits by the MRP following transfer from an Intensive Care Area
See General Preamble GP46 for terms and conditions.
C142 - first subsequent visit by the MRP following transfer from an
Intensive Care Area............................................................ 71.80
C143 - second subsequent visit by the MRP following transfer from
an Intensive Care Area ....................................................... 71.80GENERAL LISTINGS
A475 Consultation............................................................................ 192.30
Comprehensive respiratory disease consultation
This service is a consultation rendered by a specialist in respiratory disease who provides all
the appropriate elements of a consultation and spends a minimum of 75 minutes in direct
contact with the patient, exclusive of time spent rendering any other separately billable
intervention to the patient.
A470 Comprehensive respiratory disease consultation ................... 342.25
Medical record requirements:
The start and stop times must be recorded in the patient’s permanent medical record or the
amount payable for the service will be adjusted to a lesser paying fee.
[Commentary:
1.A470 must satisfy all the elements of a consultation (see page GP16).
2.Unless otherwise specified in the Schedule, the calculation of time for comprehensive
respiratory diseases consultations excludes (1) time devoted to any other service or
procedure for which an amount is payable in addition to the consultationand (2) non-patient-
facing time such as such as time spent reviewing charts, imaging, or documentation, etc.]
A575 Limited consultation ................................................................ 119.35
A476 Repeat consultation ................................................................ 119.35
A473 Medical specific assessment .................................................. 102.60
A474 Medical specific re-assessment.............................................. 75.30
A471 Complex medical specific re-assessment............................... 89.40
A478 Partial assessment ................................................................. 45.25
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%
Complex respiratory assessment
This service is an assessment for the ongoing management of the following conditions of the
respiratory system where the complexity of the condition requires the continuing management
by a respirology specialist (47):
a. chronic respiratory failure (i.e. a symptomatic patient with a PaO2 <60mmHg and/or or a
PaCO2 >50mmHg);
b. bronchiectasis with frequent infections;
c. cystic fibrosis;
d. active pulmonary or extrapulmonary disease due to mycobacterial tuberculosis complex
(latent tuberculosis infection is excluded); or
e. active pulmonary or extrapulmonary non-tuberculous mycobacterial disease (airway or
tissue colonization without disease is excluded).
A570 Complex respiratory assessment ........................................... 108.95
Payment rules:
1.A570 must include the elements of a medical specific re-assessment, or the amount payable
will be adjusted to a lesser assessment fee.CONSULTATIONS AND VISITS
RESPIRATORY DISEASE (47)
2.A570 is limited to 6 per patient, per physician, per 12 month period. Services in excess of this
limit will be adjusted to a lesser assessment fee.
3.E078 is not eligible for payment same patient same day as A570.
[Commentary:
A570 is not intended for the evaluation and/or management of uncomplicated respiratory
disorders. For example, the applicable assessment service from the general listings should be
claimed for assessment of patients for routine follow-up of uncomplicated chronic obstructive
pulmonary disease (e.g. emphysema, chronic bronchitis).]CONSULTATIONS AND VISITS
RHEUMATOLOGY (48)
For Services not listed, refer to Internal Medicine Section.
GENERAL LISTINGS
A485 Consultation............................................................................ 202.40
Comprehensive rheumatology consultation
This service is a consultation rendered by a specialist in rheumatology who provides all the
appropriate elements of a consultation and spends a minimum of seventy-five (75) minutes of
direct contact with the patient exclusive of time spent rendering any other separately billable
intervention to the patient.
A590 Comprehensive rheumatology consultation............................ 342.25
Medical record requirements:
For A590, the start and stop times must be recorded in the patient’s permanent medical record
or the amount payable for the service will be adjusted to a lesser paying fee.
[Commentary:
1.A590 must satisfy all the elements of a consultation (see page GP16).
2.Unless otherwise specified in the Schedule, the calculation of the time for comprehensive
rheumatology consultations excludes (1) time devoted to any other service or procedure for
which an amount is payable in addition to the consultation and (2) non-patient-facing time
such as such as time spent reviewing charts, imaging, or documentation, etc.]
A595 Limited consultation ................................................................ 124.50
A486 Repeat consultation ................................................................ 125.10
A483 Medical specific assessment .................................................. 95.95
A484 Medical specific re-assessment.............................................. 72.00
A481 Complex medical specific re-assessment............................... 83.40
A488 Partial assessment ................................................................. 44.75
E078 - chronic disease assessment premium (see General
Preamble GP25) ................................................ add 50%
Complex rheumatology assessment
A complex rheumatology assessment is an assessment for the ongoing management of the
following diseases of the musculoskeletal system where the complexity of the condition
requires the continuing management by a rheumatologist:
a.Systemic vasculitides;
b.Inflammatory myopathies;
c.Polymyalgia rheumatica; or
d.Paediatric vasculitides.
A480 Complex rheumatology assessment....................................... 113.85
Payment rules:
1.A complex rheumatology assessment must include the elements of a medical specific re-
assessment, or the amount payable will be adjusted to lesser assessment fee.
2.This service is not eligible for payment to a physician for the initial evaluation of the patient by
that physician.
3.Complex rheumatology assessments are limited to 6 per patient, per physician, per 12 month
period. Services in excess of this limit will be adjusted to a lesser assessment fee.
4.E078 is not eligible for payment with A480.Fee master record
Master, record 920. Record Layout PDF, page 1.
E07820230101999999990000000000000000000000000000001000000000000000000000000
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.
| Field | Raw / scale 10,000 |
|---|---|
| provider | 00000000000 / 0 |
| assistant | 00000000000 / 0 |
| specialist | 00000000100 / 0.01 |
| anaesthetist | 00000000000 / 0 |
| non anaesthetist | 00000000000 / 0 |
Explanation
AI-generated. Unreviewed.
Chronic Disease Assessment, listed under Consultations and Visits in the Virtual Care Services section, under premium. Chronic disease assessment premiums are also listed under several specialty sections.
Watch out for
Not eligible for payment with A760 or A113, and start and stop times must be recorded in the patient's permanent medical record.
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Report an issue with E078. Do not include patient names, health details or other personal information.