New Alberta Virtual Care Code Rules
The AMA and AHCIP recently notified physicians about upcoming changes to virtual care codes in Alberta. The changes will better compensate physicians, moving virtual care to a compensation structure more similar to in-person care. In this blog post, we will summarize the changes as they are released from AHCIP.
IMPORTANT: As of the date this blog post was published, the changes to AHCIP’s Claim Assessment System (CLASS) have not yet been made. Claims submitted with complexity modifiers will not be paid correctly. Physicians are requested to hold complex modifier eligible claims with dates of service effective January 1, 2022 and after until further notice. A new Medical Bulletin providing information about the completion of CLASS changes will be issued as soon as possible.
Background
Just prior to January 1, 2022, the AMA shared an updated in which they indicated there would be upcoming changes to the AHCIP Schedule of Medical Benefits (SOMB) that will allow:
- recognition of indirect patient care time
- allowing complex modifiers on lengthy visits
- aligning fees for virtual psychiatric treatment with fees for in-person care
- reducing time requirements for virtual assessments
- allowing age modifiers on visits
In the AMA’s letter, they advised physicians to “hold complex modifier eligible claims with dates of service effective January 1, 2022 and after until further notice.”
Bulletin MED 252: Enhanced Virtual Care Codes
On January 12, 2022, AHCIP issued a Medical Bulletin MED 252 (https://open.alberta.ca/dataset/58a224a2-0fed-4b1e-b8d5-9f6cf70450c6/resource/a86552b8-d684-41eb-afbc-27729290950d/download/health-ahcip-bulletin-med-252-2022-01-12.pdf). This bulletin confirm the AMA’s letter and provider further details on the changes as summarized below:
- Effective Date of Changes: The following changes made to virtual care codes will be retroactive to January 1, 2022
- Time spent on Indirect Care for Patients: Physician provided indirect care/patient management services that are related to the provision of an insured service may be included in the time calculations for virtual services. This means the time spent reviewing patient charts, completing referrals, etc. may count toward the time requirements. In order to be eligible to claim for patient management time, all services must have been completed on the same date of service as the patient virtual visit; only physician time can be claimed.
- Allowance of Complex Modifiers on Virtual Care Codes: Physicians will be allowed to bill a single complex modifier for eligible virtual visits and consultations. The following table provides further details regarding these changes
Summary of Virtual Care Code Changes by Code:
| Topic | Virtual Care HSC(s) | Eligible Specialties | Change |
|---|---|---|---|
| Indirect Care /Patient management services |
03.01AD 03.03CV 03.03FV 03.08CV |
All physicians who provide both inperson and virtual care as a part of their practice |
Time spent on patient management services can be counted towards the time requirements for relevant virtual care HSCs. |
| Complex Modifier | 03.03CV | [1] Family physicians meeting criteria. | May bill CMGP01 for a virtual limited assessment when the total time spent providing patient care is at least 15 minutes (No additional calls of CMGP are allowed). |
| 03.03CV | [2] Specialists meeting criteria from the following specialty groups: • Community medicine • Geriatric medicine • Occupational medicine • Radiation oncology • Cardiology • Endocrinology/metabolism • Hematology • Infectious diseases • Internal medicine • Medical oncology • Nephrology • Pediatrics • Pediatric cardiology • Rheumatology |
May bill CMXV15 for a virtual limited assessment when the total time spent providing patient care is at least 15 minutes. |
|
| 03.03CV | All remaining specialties not listed above i.e. [1] & [2]. |
May bill CMXV20 for a virtual limited assessment when the total time spent providing patient care is at least 20 minutes. |
|
| 03.03FV | Specialists meeting criteria from the following specialty groups: • Cardiology • Endocrinology/metabolism • Hematology • Infectious diseases • Internal medicine • Medical oncology • Nephrology • Pediatric cardiology • Pediatrics • Rheumatology |
May bill CMXV15 for a virtual follow-up assessment when the total time spent providing patient care is at least 15 minutes (referred cases only). |
|
| 03.03FV | Specialists meeting criteria from the following specialty groups: • Clinical immunology • Critical care medicine • Gastroenterology • Medical genetics • Neurology • Neonatal perinatal medicine • Pediatric gastroenterology • Pediatric neurology • Pediatric nephrology • Physical medicine • Respiratory medicine • Urology • Vascular surgery |
May bill CMXV20 for a virtual follow-up assessment when the total time spent providing patient care is at least 20 minutes (referred cases only). |
|
| 03.08CV | All physicians meeting criteria for referred cases only. |
May bill CMXC30 for a virtual consultations when the total time spent providing patient care is at least 30 minutes. |
Other Important Notes
- Virtual Care codes are not covered by the medical reciprocal agreement. Claims for virtual services are not payable for services provided to patients with out-of-province (OOP) health care coverage. That said, Statgo has been able to get some of these OOP claims paid through alternate submission methods. Please submit your OOP virtual care code claims and Statgo will make best efforts to obtain payment for you.
- As of the date this blog post was published (January 14, 2022), the changes to AHCIP’s Claim Assessment System (CLASS) have not yet been made. Claims submitted with complexity modifiers will not be paid correctly and if submitted, will need to be resubmitted for reassessment at a later date. To avoid this, physicians are requested to hold complex modifier eligible claims with dates of service effective January 1, 2022 and after until further notice. A new Medical Bulletin providing information about the completion of CLASS changes will be issued as soon as possible.