Consultation
A195 Consultation
A895 Consultation in association with special visit to a hospital inpatient, long term care inpatient or emergency department patient.
A395 Limited Consultation
A196 Repeat Consultation
*Please refer to the SoB page GP 17-19 for the detailed Consultation payment rules.
Other Consultation
A190 Special Psychiatric Consultation (required time spend a minimum of 75 minutes of direct contact with patient).
A795 Geriatric Psychiatric Consultation patient of 75 years or older, minimum of 75 minutes of direct contact with patients and must be scheduled a minimum of 24 hours prior to visit.
A695 Neurodevelopmental Consultation patient with complex neurodevelopment conditions e.g.: autism, global developmental disorders etc. Minimum of 90 minutes of direct contact with the patient.
Stop and start times must be recorded in medical record. Maximum 1 per patient per physician every 5 years.
Assessments and Interviews
Assessments
A193 Specific Assessment
A194 Partial Assessment
Interviews
A197 Consultative interview with parent(s) or patient representative less than 22 years
A198 Consultative interview with a patient less than 22 years
A191 Consultative interview with caregiver(s) of a patient at least 65 years or a patient less and 64 years with a diagnosis of dementia
A192 Consultative interview with patient of 64 years or a patient less than 64 years with a diagnosis of dementia.
**Note: A191, A192, A197, A198 are not eligible for payment for the same patient, same day as family psychiatric care or family psychotherapy (K191, K193, K195, K196)
K630 Psychiatric Consultation Extension: per unit (1/2 hour + 1 unit), limited to a maximum of 6 units per patient per physician per day.
Consultation | Minimum time with the patient before the start time for the first unit of K630 | Minimum time required for consultation service + 1 unit of K630 to be payable | [Commentary: Minimum time required for consultation service + 2 units of K630 to be payable |
A190, C190, W190 | 90 minutes | 106 minutes | 136 minutes |
A195 | 60 min | 76 min | 106 min |
A197 – sole service | 60 min | 76 min | 106 min |
A198 – sole service | 60 min | 76 min | 106 min |
A197 + A198 same patient same day | 120 min | 136 min | 166 min |
A695, C695, W695 | 120 min | 136 min | 166 min |
A795, C795, W795 | 90 min | 106 min | 136 min |
A895, C895, W895 | 60 min | 76 min | 106 min |
A191 | 60 min | 76 min | 106 min |
A192 | 60 min | 76 min | 106 min |
A191+ A192 same patient same day | 120 min | 136 minutes | 166 min |
Special Visit Premiums (Emergency Department)
*When billing Special Visit Premiums, use A-prefix consultation or assessment.
Not eligible for payment to Emergency Department Physicians (see definition GP67)
Premium | Weekdays Daytime (07:00- 17:00) | Weekdays Daytime (07:00 - 17:00) with Sacrifice of Office Hours | Evenings (17:00- 24:00) Monday through Friday | Sat., Sun. and Holidays (07:00- 24:00) | Nights (00:00- 07:00) |
Travel Premium | $36.40
K960 (max. 2 per time period) | $36.40
K961 (max. 2 per time period) | $36.40
K962 (max. 2 per time period) | $36.40
K963 (max. 6 per time period) | $36.40
K964 (no max. per time period) |
First Person Seen | $20.00
K990 (max. 10 (total of first and additional person seen) per time period) | $40.00
K992 (max. 10 (total of first and additional person seen) per time period) | $60.00
K994 (max. 10 (total of first and additional person seen) per time period) | $75.00
K998 (max. 20 (total of first and additional person seen) per time period) | $100.00
K996 (no max. per time period) |
Additional Person(s) seen | $20.00
K991 (max. 10 (total of first and additional person seen) per time period) | $40.00
K993 (max. 10 (total of first and additional person seen) per time period) | $60.00
K995 (max. 10 (total of first and additional person seen) per time period) | $75.00
K999 (max. 20 (total of first and additional person seen) per time period) | $100.00
K997 (no max. per time period) |
* Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.
Special Visit Premiums (In-Patient)
*When billing Special Visit Premiums, use A-prefix consultation or assessment.
The “C” prefix consult codes are strictly for non-emergency inpatient consults (and therefore no special visits apply).
Premium | Weekdays Daytime (07:00- 17:00) | Weekdays Daytime (07:00 - 17:00) with Sacrifice of Office Hours | Evenings (17:00- 24:00) Monday through Friday | Sat., Sun. and Holidays (07:00- 24:00) | Nights (00:00- 07:00) |
Travel Premium | $36.40 | $36.40 | $36.40 | $36.40 C963 (max. 6 per time period) | $36.40 |
First Person Seen | $20.00 | $40.00 | $60.00 | $75.00 | $100.00 |
Additional Person(s) seen | $20.00 | $40.00 | $60.00 | $75.00 | $100.00 |
* Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.
In-Patient Services
C895 Consultation
C190 Special Psychiatric Consultation
C395 Limited Consultation
C196 Repeat Consultation
C795 Geriatric Psychiatric Consultation
C695 Neurodevelopmental Consultation
C193 Specific Assessment
C194 Specific Re-Assessment
Hospital Rounding – Automatic Codes (IPTMA, IPTXA)
Service codes for rounding will differ depending on the number of days the patient has been admitted. The MDBilling.ca automatic codes allow a physician to enter one code for rounding. Our software system will automatically choose the correct (and highest paying) inpatient subsequent visit service allowed based on the admission date entered.
HOW TO USE:
IPTMA (MRP Rounding): Our system will choose the correct inpatient subsequent visit code and add the MRP premium (E083/E084) for you.
IPTXA (Non-MRP - covering): Our system will choose the correct inpatient subsequent visit code for you.
MRP Subsequent Visit Premium
E083 Weekday
E084 Saturday, Sunday or Holiday
Day / Week after admission | IPTMA (MRP Rounding) | IPTXA (Non-MRP – covering) |
1st Day | C122A + E083A/E084A | C192A |
2nd Day | C123A + E083A/E084A | |
1 – 5th Week | C192A + E083A/E084A | |
6 - 13th Week | C197A + E083A/E084A | C197A |
13th + Week | C199A + E083A/E084A | C199A |
Other Subsequent Visit by MRP
C142 + E083 1st day following transfer from ICU
C143 + E083 Second day following transfer from ICU
C124 + E083 Day of discharge (patient must be in hospital for at least 48 hours).
Other Visit
C121 Additional visit due to intercurrent illness
C198 Concurrent Care
C982 Palliative Care
Psychotherapy, Family Psychotherapy, Hypnotherapy, Psychiatric Care
*units = ½ hour | Outpatient (per unit) | In-patient (per unit) |
Psychiatric Care | K198 | K199 |
Family Psychiatric Care | K196 | K191 |
Individual Psychotherapy | K197 | K190 |
Family Psychotherapy (2 + members) | K195 | K193 |
Note: for in-patient services, the admission date and facility are required in the claim submission.
Group Psychotherapy
* per member - first 12 units per day
# of people | Outpatient (per unit) | In-patient (per unit) |
2 people | K208 | K210 |
3 people | K209 | K211 |
4 people | K203 | K200 |
5 people | K204 | K201 |
6 to 12 people | K205 | K202 |
Additional units per member
(max 6 per patient per day) | K206 | K207 |
Hypnotherapy
K192 Individual, per unit
K194 Group for induction and training for hypnosis per member (max of 8), per unit
Community Psychiatric Care Modifiers / Premiums
K187 Acute Post Discharge Psychiatry Billing Premium - Adds 15% to K195, K196, K197, K198
K188 High risk community psychiatric care (available during a 6 month period following a suicide attempt) - Adds 15% to A190, A191, A192, A195, A197, A198, A695, A795, K195, K196, K197, K198
K189 Urgent Community Psychiatric Follow up – Add $200 to A190, A195, A695, A795
Assessment under the Mental Health Act
K620 Consultation for involuntary psychiatric treatment, per unit
K623 Form 1 Application for psychiatric assessment
K624 Form 3 Certification of involuntary admission
K629 Form 3 All other re-certifications of involuntary admission including completion of forms