K005

PDF page 149 / A21

CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
     Primary mental health care
       Primary mental health care is not to be billed in conjunction with other consultations and visits
       rendered by a physician during the same patient visit unless there are clearly different
       diagnoses for the two services. Unit means ½ hour or major part thereof - see General
       Preamble GP7, GP54 to GP61 for definitions and time-keeping requirements.
   K005 Individual care............................................................. per unit 80.00
        Counselling
         Unit means ½ hour or major part thereof - see General Preamble GP7, GP54 to GP61 for
         definitions and time-keeping requirements.
       Individual care
   K013 - first three units of K013 and K040 combined per patient per
            provider per 12 month period ................................. per unit                     80.00
   K033 - additional units per patient per provider per 12 month period
             ............................................................................... per unit   56.30
       Group counselling - 2 or more persons
   K040 - where no group members have received more than 3 units
           of any counselling paid under codes K013 and K040
           combined per provider per 12 month period .......... per unit                                80.00
   K041        - additional units where any group member has received 3 or
                 more units of any counselling paid under codes K013 and
                 K040 combined per provider per 12 month period . per unit                              57.30
   K014 Counselling for transplant recipients, donors or families of
          recipients and donors
           - 1 or more persons ............................................... per unit                 80.00
   K015 Counselling of relatives - on behalf of catastrophically or
          terminally ill patient
           - 1 or more persons ............................................... per unit                 80.00

PDF page 184 / A56

CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
   Initial discussion with patient re: smoking cessation
     Initial discussion with patient re: smoking cessation is the service rendered to a patient who
     currently smokes tobacco by the primary care physician most responsible for their patient’s
     ongoing care, in accordance with the guidelines and subject to the conditions below.
 E079 Initial discussion with patient, to eligible services ............. add         15.95
     Payment rules:
     1.E079 is only eligible for payment when rendered in conjunction with one of the following
        services: A001, A003, A004, A005, A006, A007, A008, A905, K005, K007, K013, K017,
        K130, K131, K132, K133, P003, P004, P005, P008, W001, W002, W003, W004, W008,
        W010, W102, W104, W107, W109 or W121.
     2.E079 is limited to a maximum of one service per patient per 12 month period.
     Medical record requirements:
     The medical record for this service must document that an initial smoking cessation discussion
     has taken place, by either completion of a flow sheet or other documentation consistent with
     the most current guidelines of the “Clinical Tobacco Intervention” (CTI) program, or the service
     is not eligible for payment.
     [Commentary:
     1.Physicians may complete a flow sheet or alternatively document that an initial discussion
       consistent with the 5A's model of the CTI program has taken place.
     2.E079 is not eligible for payment for discussions related to cannabis smoking or discussions
       related to vaping, including vaping tobacco.]
   Smoking cessation follow-up visit
     Smoking cessation follow-up visit is the service rendered by a primary care physician in the 12
     months following E079 that is dedicated to a discussion of tobacco smoking cessation, in
     accordance with the guidelines and subject to the conditions below.
 K039 Smoking cessation follow-up visit ........................................... 39.25
     Payment rules:
     1.K039 is only eligible for payment when E079 is payable to the same physician in the
       preceding 12 month period.
     2.K039 is limited to a maximum of two services in the 12 months following E079.
     Medical record requirements:
     The medical record for this service must document that a follow-up visit regarding smoking
     cessation has taken place, by either completion of a flow sheet or other documentation
     consistent with the most current guidelines of the “Clinical Tobacco Intervention” (CTI)
     program, or the service is not eligible for payment.
     [Commentary:
     1.Physicians may complete a flow sheet or alternatively document that an initial discussion
       consistent with the 5A's model of the CTI program has taken place.
     2.K039 is not eligible for payment for discussions related to cannabis smoking or discussions
       related to vaping, including vaping tobacco.]

PDF page 198 / A70

CONSULTATIONS AND VISITS
VIRTUAL CARE SERVICES
     Claims submission instructions:
     Comprehensive Virtual Care Services rendered within an Existing/Ongoing Patient-Physician
     Relationship must be claimed using the fee codes listed in Appendix J – Section 1.
     Claims submitted for Comprehensive Virtual Care Services must include the modality indicator
     that identifies the technology used to deliver the service:
        K300A – identifies Video technology used during the service
        K301A – identifies Telephone technology (audio only) used during the service
     Submit claims for Comprehensive Virtual Care Services using the in-person fee value
     regardless of whether the service is rendered by Video or Telephone. Payments for Telephone
     services will be automatically reduced as set out below.
     Limited Virtual Care Services rendered outside of an Existing/Ongoing Patient-Physician
     Relationship must be claimed using the fee codes listed in Appendix J – Section 2.
     Payment rules:
     Comprehensive Virtual Care Services rendered by Video are payable at fees that are
     equivalent to the corresponding in-person fees for those services; or for Limited Virtual Care
     Services, the fees listed in Appendix J – Section 2 that correspond to those services.
     The amount payable for Comprehensive Virtual Care Services rendered by Telephone is 85%
     of the corresponding in-person fee except for K007, K005, K197 and K198 which will be
     payable at 95% of the corresponding in-person fee.

PDF page 300 / A172

CONSULTATIONS AND VISITS
PAEDIATRICS (26)
   Developmental and/or behavioural care
     Developmental and/or behavioural care are services encompassing any combination or form of
     assessment and treatment by a paediatrician for mental illness, behavioural maladaptations,
     developmental disorders, and/or other problems that are assumed to be of a developmental or
     emotional nature where there is consideration of the patient's biological and psychosocial
     functioning. Unit means ½ hour or major part thereof - see General Preamble GP7, GP54 to
     GP61 for definitions and time-keeping requirements.
 K122 - individual developmental and/or behavioural care . per unit                 102.35
 K123 - family developmental and/or behavioural care ...... per unit                116.15
     Payment rules:
     These services are only payable to paediatricians who satisfy one of the following criteria:
        a.35% or more of the dollar value of the annual fee-for-service claims in any 12 month
          period consist of K122 and/or K123;
        b.35% or more of the dollar value of the annual fee-for-service claims in any 12 month
          period consist of any combination of K005, K007, K019, K020, K012, K024, K025, K010,
          K004, K006, or K008; or
        c.additional residency or fellowship training in paediatrics or psychiatry. Residency or
          fellowship training includes either completion of training in paediatric or adolescent
          developmental and/or behavioural medicine within a recognized paediatric residency
          training programme of at least one-year duration following completion of the first three
          years of residency, or a post residency fellowship or other equivalent programme in
          paediatrics, adolescent medicine or psychiatry. Documentation of additional residency or
          fellowship training must be provided if requested by the ministry.
     [Commentary:
     Paediatricians who do not meet the criteria listed above but believe they have appropriate
     training and/or experience to permit them to provide paediatric or adolescent developmental
     and/or behavioural care may contact the ministry to determine whether their training and/or
     experience constitute an equivalent residency, training or programme.
     Services rendered by physicians who do not meet these requirements are still insured but
     eligible for payment under another fee schedule code e.g. primary mental health care (K005),
     counselling (K013/K033) or group counselling (K040/K041).]

Master, record 2884. Record Layout PDF, page 1.

K00520260401999999990000080000000000000000000000000000000000000000000000000

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.