K037

PDF page 42 / GP28

FIRST VISIT BY PRIMARY CARE PHYSICIAN AFTER HOSPITAL DISCHARGE
  E080 First visit after hospital discharge premium, to other service
          listed in payment rule 5 below ..................................... add        25.90
      Payment rules:
      1.Subject to payment rules 2 through 5, E080 is only eligible for payment for a visit with the
        patient's primary care physician in the physician’s office or the patient’s home within two
        weeks of discharge following in-patient admission to an acute care hospital.
      [Commentary:
      This premium is not payable for visits rendered to patients in locations other than the
      physician's office or patient's home. As such, the premium is not payable for services rendered
      in places such as Nursing Homes, Homes for the Aged, chronic care hospitals, etc.]
      2.E080 is not eligible for payment if the admission to hospital was for the purpose of obstetrical
        delivery unless the mother required admission to an ICU during the hospital stay.
      3.E080 is not eligible for payment if the admission to hospital was for the purpose of newborn
        care unless the infant required admission to a NICU during the hospital stay.
      4.E080 is not eligible for payment if the admission to hospital was for the purpose of performing
        day surgery.
      5.E080 is only eligible for payment when rendered with the following services:
        A001, A003, A004, A007, A008, A261, A262, A263, A264, A888, A900, K004–K008, K013,
        K014, K022, K023, K028-K030, K032, K033, K037, K623, P003, P004, P008.

PDF page 179 / A51

Fibromyalgia/myalgic encephalomyelitis care
       Fibromyalgia/myalgic encephalomyelitis care is the provision of care to patients with
       fibromyalgia or myalgic encephalomyelitis. The service includes the common and specific
       elements of all insured services listed under “Family Practice & Practice In General” in the
       “Consultations and Visits” section of the Schedule.
   K037 Fibromyalgia/myalgic encephalomyelitis care ............ per unit              80.00
       Payment rules:
       1.K037 is a time based service with time calculated based on units. Unit means ½ hour or
          major part thereof – see General Preamble GP7, GP55 for definitions and time-keeping
          requirements.
          2.No other consultation, assessment, visit or time based service is eligible for payment when
            rendered the same day as K037 to the same patient by the same physician.

Master, record 2915. Record Layout PDF, page 1.

K03720260401999999990000080000000000000000000000000000000000000000000000000

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.