The PCPCM uses already existing fee-for-service (FFS) health service codes (HSC). In-basket codes are paid at 68.5% of the FFS value. Any health service codes that are not listed as in-basket codes below, are considered out-of-basket codes and are paid at 100% of the FFS rate.
It is important to note that complexity modifiers CMGP and CMXC30 cannot be claimed under the PCPCM.
PCPCM In-Basket Visit Codes
Visit HSCs | Description |
03.01AD | Diagnostic interview and evaluation, unqualified {Advice to a patient or their agent (agent as defined in the Personal Directives Act) via telephone, secure email or videoconference} |
03.01B | Diagnostic interview and evaluation, unqualified {Patient care advice provided to community mental health care workers, child protection workers, group home staff, or educational personnel weekdays 0700 to 1700 hours in relation to the care and treatment of a patient receiving community mental health care services under the Alberta community mental health care program.} |
03.01BA | Diagnostic interview and evaluation, unqualified {Patient care advice provided to community mental health care workers, child protection workers, group home staff, or educational personnel weekdays 1700 to 2200 hours, weekends and statutory holidays 0700 to 2200 hours in relation to the care and treatment of a patient receiving community mental health care services under the Alberta community mental health care program.} |
03.01BB | Diagnostic interview and evaluation, unqualified {Patient care advice provided to community mental health care workers, child protection workers, group home staff, or educational personnel any day 2200 to 0700 hours in relation to the care and treatment of a patient receiving community mental health care services under the Alberta community mental health care program.} |
03.01C | Diagnostic interview and evaluation, unqualified {Telehealth assistance service} |
03.01CC | Telephone advice and counselling to a patient or their agent (agent as defined in the Personal Directives Act) regarding the COVID-19 vaccine |
03.01LG | Diagnostic interview and evaluation, unqualified {Physician to physician or podiatric surgeon telephone or telehealth videoconference or secure videoconference consultation, referring physician, weekdays 0700 to 1700 hours} |
03.01LH | Diagnostic interview and evaluation, unqualified {Physician to physician or podiatric surgeon telephone or telehealth videoconference or secure videoconference consultation, referring physician, weekdays 1700 to 2200 hours, weekends and statutory holidays 0700 to 2200 hours} |
03.01LI | Diagnostic interview and evaluation, unqualified {Physician to physician or podiatric surgeon telephone or telehealth videoconference or secure videoconference consultation, referring physician, any day 2200 to 0700 hours} |
03.01LJ | Diagnostic interview and evaluation, unqualified {Physician, nurse practitioner, midwife or podiatric surgeon to physician telephone or telehealth videoconference or secure videoconference consultation, consultant, weekdays 0700 to 1700 hours} |
03.01LK | Diagnostic interview and evaluation, unqualified {Physician, nurse practitioner, midwife or podiatric surgeon to physician telephone or telehealth videoconference or secure videoconference consultation, consultant, weekdays 1700 to 2200 hours, weekends and statutory holidays 0700 to 2200 hours} |
03.01LL | Diagnostic interview and evaluation, unqualified {Physician, nurse practitioner, midwife or podiatric surgeon to physician telephone or telehealth videoconference or secure videoconference consultation, consultant, any day 2200 to 0700 hours} |
03.01N | Diagnostic interview and evaluation, unqualified {Management of anticoagulant therapy to include ordering necessary blood tests, interpreting results, adjusting the anticoagulant dosage as required} |
03.01NG | Diagnostic interview and evaluation, unqualified {Patient care advice to paramedic - pre hospital patch, Mobile Integrated Healthcare Unit paramedic, assisted living/designated assisted living and lodge staff, active treatment facility worker for hospital in-patient, long term care worker for patients in a long term care facility, nurse practitioner, hospice worker, home care worker, midwife or public health nurse weekdays 0700 to 1700 hours, provided via telephone or other telecommunication methods, in relation to the care and treatment of a patient} |
03.01NH | Diagnostic interview and evaluation, unqualified {Patient care advice to paramedic - pre hospital patch, Mobile Integrated Healthcare Unit paramedic, assisted living/designated assisted living and lodge staff, active treatment facility worker for hospital in-patient, long term care worker for patients in a long term care facility, nurse practitioner, hospice worker, home care worker, midwife or public health nurse weekdays 1700 to 2200 hours, weekends and statutory holidays, 0700 to 2200 hours, provided via telephone or other telecommunication methods, in relation to the care and treatment of a patient} |
03.01NI | Diagnostic interview and evaluation, unqualified {Patient care advice to paramedic - pre hospital patch, Mobile Integrated Healthcare Unit paramedic, assisted living/designated assisted living and lodge staff, active treatment facility worker for hospital in-patient, long term care worker for patients in a long term care facility, nurse practitioner, hospice worker, home care worker, midwife or public health nurse any day 2200 to 0700 hours, provided via telephone or other telecommunication methods, in relation to the care and treatment of a patient} |
03.01NM | Diagnostic interview and evaluation, unqualified {Patient care advice to a pharmacist provided via telephone or other telecommunication methods in relation to the care and treatment of a patient} |
03.01O | Diagnostic interview and evaluation, unqualified {Physician or Nurse Practitioner to Physician secure E-Consultation, consultant} |
03.01R | Diagnostic interview and evaluation, unqualified {Physician to Physician secure E-Consultation, referring physician} |
03.01S | Diagnostic interview and evaluation, unqualified {Physician to patient secure electronic communication} |
03.01T | Diagnostic interview and evaluation, unqualified {Physician to patient secure videoconference} |
03.02A | Diagnostic interview and evaluation, described as brief {Brief assessment of a patient's condition requiring a minimal history with little or no physical examination} |
03.03A | Diagnostic interview and evaluation, described as limited {Limited assessment of a patient's condition requiring a history related to the presenting problems, an examination of the relevant body systems, appropriate records, and advice to the patient - in office.} |
03.03B | Diagnostic interview and evaluation, described as limited {Prenatal visit - in office.} |
03.03C | Diagnostic interview and evaluation, described as limited {Routine post-natal office examination} |
03.03CV | Diagnostic interview and evaluation, described as limited {Assessment of a patient's condition via telephone or secure videoconference.} |
03.03N | Diagnostic interview and evaluation, described as limited {Home visit - first patient} <<Home Visits>> |
03.03P | Diagnostic interview and evaluation, described as limited {Home visit - second/subsequent patients} |
03.04A | Diagnostic interview and evaluation, described as comprehensive {Comprehensive assessment of a patient's condition requiring a complete history, a complete physical examination appropriate to the physician's specialty, an appropriate record and advice to the patient - in office.} |
03.04B | Diagnostic interview and evaluation, described as comprehensive {Initial prenatal visit requiring complete history and physical examination} |
03.04I | Diagnostic interview and evaluation, described as comprehensive {Comprehensive visit, including completion of form, required for admission to a regional health authority addiction residential treatment centre} |
03.04K | Diagnostic interview and evaluation, described as comprehensive {Comprehensive geriatric assessment, first full 90 minutes} |
03.04M | Diagnostic interview and evaluation, described as comprehensive {Pre-operative history and physical examination in relation to an insured service} |
03.04N | Diagnostic interview and evaluation, described as comprehensive {Comprehensive evaluation including completion of forms to determine capacity as defined by the Personal Directives Act (PDA) (RSA 2007 s9(2)(a))} |
03.04Q | Diagnostic interview and evaluation, described as comprehensive {Post surgical cancer surveillance examination} |
03.05I | Other diagnostic interview and evaluation {Direct care, reassessment, education and/or general counselling of a patient requiring palliative care, per 15 minutes or portion thereof - in office or a patient's home} |
03.05JA | Other diagnostic interview and evaluation {Formal, scheduled, multiple health discipline team conference, full 15 minutes or major portion thereof for the first call when only one call is claimed} <With para-medical personnel regarding the provision of health care where social and other issues are involved> |
03.05JB | Other diagnostic interview and evaluation {Formal, scheduled family conference relating to a specific patient, per 15 minutes or major portion thereof} |
03.05JH | Other diagnostic interview and evaluation {Family conference via telephone, in regards to a community patient} |
03.05JN | Other diagnostic interview and evaluation {Second and subsequent physician attendance at a formal, scheduled, professional conference related to the care and treatment of multiple patients undergoing rehabilitation therapy including those with chronic pain, when discussion occurs on behalf of a specific patient per full 5 minutes to a maximum of 6 units in a 30 minute period} |
03.05JQ | Other diagnostic interview and evaluation {Family conference with relative(s) via telephone in connection with the management of a patient with a psychiatric disorder} |
03.05JR | Other diagnostic interview and evaluation {Physician telephone call directly to patient, to discuss patient management/diagnostic test results} |
03.05LA | Other diagnostic interview and evaluation {Group session, multiple patients, where a physician is involved in providing care and teaching to patients in attendance} |
03.05O | Other diagnostic interview and evaluation {Direct management, reassessment, education and/or general counselling of a patient with chronic pain, per 15 minutes or portion thereof} |
03.05T | Other diagnostic interview and evaluation {Formal, scheduled, professional interview relating to the care and treatment of a palliative care patient with other physicians, family, and/or direct therapeutic supervision of allied health professionals or community agencies, on behalf of a specific patient, full 15 minutes or major portion thereof for the first call when only one call is claimed} |
03.05U | Other diagnostic interview and evaluation {Second and subsequent physician attendance at formal, scheduled, professional interview relating to the care and treatment of a palliative care patient with other physicians, family and/or direct therapeutic supervision of allied health professionals or community agencies, on behalf of a specific patient, full 15 minutes or major portion thereof for the first call when only one call is claimed} |
03.05V | Other diagnostic interview and evaluation {Formal, scheduled, professional interview relating to the care and treatment of a patient with chronic pain with other physicians, and/or direct therapeutic supervision of allied health professionals or community agencies, on behalf of a specific patient, per 15 minutes} |
03.05X | Other diagnostic interview and evaluation {Formal, scheduled, professional interview with relative(s) relating to the care and treatment of a patient with chronic pain on behalf of a specific patient, full 15 minutes or major portion thereof for the first call when only one call is claimed} |
03.07A | Consultation, described as limited {Minor consultation - in office} |
03.07B | Consultation, described as limited {Repeat consultation} |
03.08A | Consultation, described as comprehensive {Comprehensive consultation - in office} |
03.08CV | Consultation, described as comprehensive {Comprehensive consultation via telephone or secure videoconference} |
03.08F | Consultation, described as comprehensive {Formal, comprehensive consultation, for a patient with chronic pain, full 60 minutes or major portion thereof for the first call when only one call is claimed} |
07.57B | Application of other wound dressing {Subsequent treatment - minor burns - dressing and/or debridement} |
08.19CW | Other psychiatric evaluation and interview {Telephone or secure videoconference with a patient for scheduled psychiatric treatment or for a palliative care or a chronic pain visit by an eligible physician, per 15 minutes or major portion thereof.} |
08.19D | Other psychiatric evaluation and interview {Professional interview with relative(s) in connection with the management of a patient with a psychiatric disorder, but without the patient being present during the interview, per 15 minutes or major portion thereof} |
08.19F | Other psychiatric evaluation and interview {Formal, scheduled, professional conference related to the care and treatment of a psychiatric patient with other physician(s), and/or direct therapeutic supervision of, allied health professionals, educational, correctional and other community agencies on behalf of a specific patient, provided by the physician most responsible for the patient's care, per 15 minutes or major portion thereof} |
08.19G | Other psychiatric evaluation and interview {Direct contact with an individual patient for psychiatric treatment (including medical psychotherapy and medication prescription), psychiatric reassessment, patient education and/or general psychiatric counselling, per 15 minutes or major portion thereof - in office.} |
08.19H | Other psychiatric evaluation and interview {Second and subsequent physician attendance at a formal, scheduled, professional conference related to the care and treatment of a psychiatric patient, on behalf of a specific patient, per 15 minutes or major portion thereof} |
08.19J | Other psychiatric evaluation and interview {Formal, scheduled, professional conference related to the care and treatment of multiple psychiatric patients with other physician(s), allied health professionals, educational, correctional and other community agencies on behalf of a specific patient, provided by the physician most responsible for the patient's care} |
08.19K | Other psychiatric evaluation and interview {Second and subsequent physician attendance at a formal, scheduled, professional conference related to the care and treatment of multiple psychiatric patients, when discussion occurs on behalf of a specific patient} |
08.44A | Group therapy {Group psychotherapy, where all members of the group are receiving therapy in the session, full 15 minutes or major portion thereof for the first call when only one call is claimed} |
08.45 | Family therapy {Assessment or therapy of a family, requiring comprehensive psychiatric or family systems evaluation, first full 45 minutes or major portion thereof for the first call when only one call is claimed - in office.} |
13.59V | Immunization and administration of COVID-19 vaccine |
13.59VA | Prolonged COVID-19 vaccination - physician time only, greater than 10 minutes |
13.82A | Ultraviolet light therapy {Psoralen ultraviolet A treatment, ultraviolet B or narrow-band ultraviolet B treatment} |
13.99J | Other diagnostic interview and evaluation {Medical emergency detention time, per 15 minutes} |
98.12S | Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Non surgical treatment, cryotherapy} <<Condylomata acuminata>> |
PCPCM In-Basket Procedure Codes
Procedure HSCs | Description |
03.12A | Measurements and manual examination of nervous system and sense organs {Intraocular pressure measurement, unilateral or bilateral} |
07.57A | Application of other wound dressing {Initial treatment - minor burn} |
10.16B | Insertion of other vaginal pessary {Pessary removal, adjustment and/or reinsertion} |
11.71A | Removal of intrauterine contraceptive device (IUD) {Removal of intrauterine contraceptive device (IUD)} |
12.21 | Removal of intraluminal foreign body from ear without incision |
13.42A | Immunization for allergy {Desensitization treatments with allergy serums} |
13.53B | Injection of steroid {Intralesional injection(s) of steroid} |
13.59A | Injection or infusion of other therapeutic or prophylactic substance nec {Intramuscular or subcutaneous injections} |
13.59J | Injection or infusion of therapeutic or prophylactic substance NEC {Injection with local anesthetic of myofascial trigger points} |
13.59O | Injection or infusion of therapeutic or prophylactic substance NEC {Injections of Botulinum A Toxin for the prophylaxis of chronic migraine headaches for eligible patients 18-65 years of age} |
13.99BA | Other miscellaneous diagnostic and therapeutic procedures NEC {Periodic Papanicolaou Smear for patients between the ages of 21 and 69} |
13.99BE | Other miscellaneous diagnostic and therapeutic procedures NEC {Pelvic examination using a speculum requiring swab(s) and/or sample(s) collection} |
17.71A | Peripheral nerve injection, unqualified {Local block(s) of somatic nerve(s)} |
37.91A | Lingual frenotomy {Release of simple tongue tie, clipping} |
51.92A | Injection of sclerosing agent or solution into vein {Varicose vein, single injection} |
51.92B | Injection of sclerosing agent or solution into vein {Varicose vein, additional injection} |
80.83B | Uterine biopsy {Endometrial biopsy} |
81.8 | Insertion of intra-uterine contraceptive device |
93.91A | Arthrocentesis {Joint aspiration, injection, hip} |
93.91B | Arthrocentesis {Joint aspiration, injection, other joints} |
95.93 | Injection/aspiration of therapeutic substance into bursa <Subacromial> |
95.94A | Injection of therapeutic substance into other soft tissue {Injection with local anesthetic of myofascial trigger points combined with a spray and stretch technique} |
95.96A | Aspiration of other soft tissue {Other bursae, tendon sheaths, ganglion of wrist or ankle, aspiration, injection} |
98.01A | Tattooing or insertion into skin and subcutaneous tissue {Implantation of subdermal contraceptive implant} |
98.03A | Other incision with drainage of skin and subcutaneous tissue {Incision and drainage of abscess or hematoma, subcutaneous or submucous} |
98.04B | Incision with removal of foreign body of skin and subcutaneous tissue {Incision with removal of foreign body of skin and subcutaneous tissue without anesthesia} |
98.11A | Debridement of wound or infected tissue {Non-functional area, up to 32 total square cms} |
98.11D | Debridement of wound or infected tissue {Functional area, up to 32 total square cms} |
98.12A | Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Excisional biopsy, skin} |
98.12B | Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Excisional biopsy, skin of face} |
98.12C | Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal of sebaceous cyst} |
98.12H | Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Excision of soft tissue tumor(s) (subcutaneous) full 30 minutes of operating time or major portion thereof for the first call when only one call is claimed} |
98.12J | Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal or excision, first lesion} |
98.12K | Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal by fulguration, first lesion} |
98.12L | Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Non-surgical treatment (cryotherapy, chemotherapy), warts or keratoses} |
98.12M | Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal of pigmented benign nevus, excluding face} |
98.12N | Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal of pigmented benign nevus of the face} |
98.12Q | Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal of any atypical or neoplastic lesion(s) - any method excluding cryotherapy for actinic keratoses} <<Multiple dysplastic or localized carcinomatous lesions of the skin>> |
98.12R | Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal of first plantar wart} |
98.22A | Suture of skin and subcutaneous tissue of other sites {Laceration, face, up to 2.5 cms (1 unit) or body, up to 5 cms (1 unit)} |
98.22B | Suture of skin and subcutaneous tissue of other sites {Laceration, face, over 2.5 cms (1 unit) and/or body, over 5 cms (1 unit)} <For each layer or unit, refer to Price List> |
98.81A | Biopsy of skin and subcutaneous tissue {Biopsy, skin} |
98.81B | Biopsy of skin and subcutaneous tissue {Punch biopsy} |
98.96A | Removal of nail, nailbed or nailfold {Wedge excision} |
98.99AA | Other operations on skin and subcutaneous tissue NEC {Acne surgery}<For incision and drainage and/or cryotherapy of cysts; and superficial peels for acne including liquid nitrogen and glycolic peels> |
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