K198

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 316 / A188

Acute post-discharge community psychiatric care
     Acute post-discharge community psychiatric care is a premium for a service that occurs during
     the (4) week period immediately following discharge where the patient was a hospital in-patient
     for treatment of a psychiatric condition. The premium is only applicable to K195, K196, K197 or
     K198.
 K187 Acute post-discharge community psychiatric care, to K195,
           K196, K197 or K198 ............................................. add 15%
   High risk community psychiatric care
     High risk community psychiatric care is a premium for a service that occurs during the six (6)
     month period following a suicide attempt. For the purposes of this premium, suicide attempts
     include self-harm attempts with intent to commit suicide or high lethality self-harm attempts, but
     do not include self harm attempts of low lethality with no intent to commit suicide. The premium
     is applicable to A190, A191, A192, A195, A197, A198, A695, A795, K195, K196, K197 and
     K198.
 K188 High risk community psychiatric care, to A190, A191, A192,
          A195, A197, A198, A695, A795, K195, K196, K197 or K198
           ............................................................................. add 15%
     Payment rules:
     1.K187 or K188 are both payable with K195, K196, K197 or K198 when rendered during the
       first four (4) week period following discharge where the patient was a hospital in-patient for
       treatment of a psychiatric condition and the requirements for both K187 and K188 are met.
     2.K188 is not eligible for payment in addition to K189 on the same patient same day.
 K189 Urgent community psychiatric follow-up, to A190, A195, A192,
         A198, A695 or A795 ..................................................... add 216.30
     Payment rules:
     1.K189 is only eligible for payment when the psychiatrist providing the urgent community
       psychiatric follow-up:
        a.renders a service described by A190, A195, A192, A198, A695 or A795 to an out-patient
          on an urgent basis during the four (4) week period immediately following discharge where
          the patient was a hospital in-patient for treatment of a psychiatric condition;
        b.did not provide services to the same patient during the same psychiatric hospital
          admission; and
        c.will continue appropriate care of the out-patient for a minimum of six (6) months as
          required.
     2.K189 is limited to a maximum of one per physician per patient per 12 month period.

PDF page 318 / A190

CONSULTATIONS AND VISITS
PSYCHIATRY (19)
     PSYCHOTHERAPY, FAMILY PSYCHOTHERAPY, HYPNOTHERAPY AND PSYCHIATRIC
     CARE
       Note:
       1.For conditions and definitions - see General Preamble GP54 to GP61.
       2.For electroconvulsive therapy fees, see Diagnostic and Therapeutic Procedures.
       3.When claiming group therapy only services rendered to one group are payable at the same
         time
       4.Unit means ½ hour or major part thereof - see General Preamble GP7, GP55 for definitions
         and time-keeping requirements.
   Psychiatric care
 K198 - out-patient .............................................................. per unit                   102.35
 K199 - in-patient................................................................. per unit                  118.00
   Family psychiatric care
 K196 - out-patient .............................................................. per unit  116.15
 K191 - in-patient................................................................. per unit 134.00
     Note:
     Family psychotherapy is claimed against the patient’s health number and diagnosis.
   Psychotherapy
 K197 Individual out-patient psychotherapy .......................... per unit                                102.35
 K190 Individual in-patient psychotherapy ............................ per unit                               107.25
 K195 Family psychotherapy - out-patients (two or more members)
        ............................................................................... per unit               116.15
 K193 Family psychotherapy - in-patients (two or more members)
        ............................................................................... per unit              121.65
   Group psychotherapy, out-patients - per member - first 12 units per day
 K208 - 2 people.................................................................. per unit                     51.20
 K209 - 3 people.................................................................. per unit                     34.10
 K203 - 4 people.................................................................. per unit                     25.60
 K204 - 5 people.................................................................. per unit                     20.45
 K205 - 6 to 12 people......................................................... per unit                        18.45
 K206 - additional units - per member (maximum 6 per patient per
        day) ........................................................................ per unit                  16.40
   Group psychotherapy, in-patients - per member - first 12 units per day
 K210 - 2 people.................................................................. per unit                     53.70
 K211 - 3 people.................................................................. per unit                     35.80
 K200 - 4 people.................................................................. per unit                     26.75
 K201 - 5 people.................................................................. per unit                     21.40
 K202 - 6 to 12 people......................................................... per unit                        19.35
 K207 - additional units - per member (maximum 6 per patient per
        day) ........................................................................ per unit                  16.40

Master, record 2990. Record Layout PDF, page 1.

K19820260401999999990000000000000000000000000010235000000000000000000000000

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.