Medical Payment Schedule - health.gov.nl.ca

1 Mcp Medical Care Plan Medical Payment Schedule Medical Care Plan Department of Health & Community Services June 1, 2013 June 1, 2013 TABLE OF CONTENTS PAGE CONTENTS i A-1 Payment Schedule Identification Changes, etc. to the Payment Schedule Effective Date of Listed Services NLMA Involvement A-1 A-4 Payment Schedule Layout with descriptions of each section of the Schedule as follows: Listing of the Sections General Preamble Appendices Visit Premiums Consultations and Visits Telemedicine Critical Care Diagnostic and Therapeutic Services In-Hospital Diagnostic and Therapeutic Services Radiology Nuclear Medicine Obstetrics Anaesthesia for Surgical-Dental Procedures Surgical Procedures Tables A-5 A-6 Insured/Non-Insured Services, with divisions as follows.

2 Insured Services Non-Insured Services Common Elements of Insured Services A-7 A-9 Claim Submission Rules Documentation Requirements Minimum Required Documentation for Claims Independent Consideration Submission Provider Billing Number Time Limitations on Claim Submission A-10 A-13 Definitions of Terms/Conditions A-10 A-11 Site of Insured Service, with some rules regarding each, as follows: Office Home Hospital In-Patient Hospital Out-Patient and Emergency Department Visits to Other Sites A-11 A-12 Delegated Procedures Age (of Patients) Defined Most Responsible Physician Defined Referral and Transferral Defined A-12 Rules re Transferrals A-12 A-13 Team Care in Teaching Units June 1, 2013 TABLE OF CONTENTS PAGE CONTENTS ii A-14 A-18 Consultations A-14 Consultations Defined A-14 Documentation of Consultations A-14 A-15 Rules Applicable to Consultations A-15 A-18 Major Consultations Defined and with rules specific to each A-19 A-31 Definitions and Rules for each visit type, other than consultations, listed in alphabetical order of first letter of the visit name as listed in the Visits Section.

3 A-32 A34 Critical Care Section of the Schedule described, giving the rules for billing from it. A-35 A37 Diagnostic and Therapeutic Procedures Section of the Schedule described, giving the rules for billing from it. A-37 In-Hospital Diagnostic Procedures Section of the Schedule described, giving the rules for billing from it. A-38 A-40 Radiology Section of the Schedule described, giving the rules for billing from it. A-41 Nuclear Medicine Section of the Schedule described, giving the rules for billing from it. A-38 A-53 Specific Rules for Billing A-38 A-41 Radiology/Nuclear Medicine Services A-42 Obstetric Services A-43 A-45 Surgical Procedures, generally A-46 A-47 Fracture Care A-48 Surgical Assist Standard Method A-48 A-49 Surgical Assist Dedicated Time Method A-49 Specialist Assistant A-50 A-53 Anaesthesiology Services A-54 A-56 Premiums A-54 A-56 General Rules for Billings Premiums.

4 Both Visit and Procedure A-54 A-56 Specific Rules for Billing Visit Premiums A-55 A-56 Specific Rules for Billing Procedure Premiums A-56 Specific Rules for Billing Delivery Premiums A-57 A-58 Specific Rules for Billing Sessional Arrangements, listed as follows: A-57 General Policy for all Sessional Arrangements A-57 A-58 Rules Specific to Organized Sessional Clinics and Institutional Care A-58 Rules Specific to On-Site Emergency Department Coverage Category Facilities A-58 Rules Specific to Dedicated On-Site 24-Hour ICU Sessional Coverage A-59 Specific Rules for Billing for Emergency Department Coverage by General Practitioners Category B Facilities A-60 Specific Rules for Billing Long Term Care Facility Coverage by General Practitioners A-61 A-62 Rural General Practitioner Hospital Premium A-63 Physician Registration A-63 Locum Coverage June 29.

5 2018 TABLE OF CONTENTS PAGE CONTENTS iii A-64 Appendix A Category A Approved Facilities for 24-Hour On-Site Emergency Department Coverage A-65 Appendix B Category B Approved Facilities for 24-Hour Emergency Department Coverage A-66 Appendix C DOHCS Designated Long Term Care Facilities with Long Term Beds A-67 A-68 Appendix D Immunization of Designated Target Populations A-69 Appendix E Non-Insured Services List A-70 Appendix F Scar Revision A-71 Appendix G Hyperbaric Oxygen Therapy B-1 B-2 Visit Premiums Listing B-1 Office B-1 Home B-1 Hospital In-Patient B-2 Hospital Out-Patient and Emergency C-1 C-27 Visits Listings by Specialty, beginning with General Practice, and, from there in alphabetical order by primary specialty name C-1 C-4 General Practice C-5 Anaesthesiology C-6 Dermatology C-7 Emergency Medicine Specialist C-8 General, Cardiac, Vascular or Thoracic Surgery C-9 Internal Medicine C-10 Nuclear Medicine Specialist C-11 Developmental Neurology C-12 Neurology (except Developmental)

6 C-13 Neurosurgery C-14 Obstetrics and Gynecology and Gynecological Oncology C-15 Ophthalmology C-16 Orthopaedic Surgery C-17 Otolaryngology C-18 C-19 Paediatrics (except Developmental Paediatrics) C-20 C-21 Developmental Paediatrics C-22 Physical Medicine C-23 Plastic Surgery C-24 C-25 Psychiatry C-26 Urology C-27 Radiology C-28 Telemedicine Preamble C-28 General Policy C-28 C-29 Terms and Conditions C-30 C-47 Telemedicine Consultations and Reassessments C-30 General Practice C-31 Dermatology June 29, 2018 TABLE OF CONTENTS PAGE CONTENTS iv C-32 General Surgery C-33 Internal Medicine C-34 Nuclear Medicine C-35 Developmental Neurology C-36 Neurology C-37 Neurosurgery C-38 Obstetrics and Gynecology C-39 Ophthalmology C-40 Orthopaedics C-41 Otolaryngology C-42 Paediatrics C-43 Developmental Paediatrics C-44 Physical Medicine C-45 Plastic Surgery C-46 Psychiatry C-47 Urology C-48 C-50 Approved Telemedicine Sites D-1 D-3 Critical Care Listing D-1 Neonatal Intensive Care D-2 ICU and CCU D-3 Cardio-Pulmonary Resuscitation D-3 Provincial

7 Perinatal High Risk Unit E-1 E-23 Diagnostic and Therapeutic Services E-1 Allergy E2 E-3 Anaesthesiology/Therapeutic E-4 Hyperbaric Oxygen Therapy E-5 E-9 Cardiovascular E-10 Dermatology E-11 Dialysis E-12 Endocrinology and Metabolism E-12 Gastroenterology E-13 General Practice E-13 Gynecology E-14 E-16 Injections or Infusions E-17 Neurology E-17 E-19 Ophthalmology E-20 Otolaryngology E-21 Physical Medicine E-22 Psychiatry E-22 Urology E-22 Venipuncture E-23 Clinical Procedures Associated with Diagnostic Radiological Examinations F-1 F-7 In-Hospital Diagnostic and Therapeutic Services Listings F-1 Electrocardiograms F-1 Electromyography and Nerve Conduction F-1 Electroencephalography F-1 Sleep Apnea Studies F-2 Evoked Potential Studies June 1.

8 2013 TABLE OF CONTENTS PAGE CONTENTS v F-2 Dermatology F-3 F-4 Obstetrics and Gynecology F-4 Ophthalmology F-5 Organized Pain Clinic F-5 Otolaryngology F-6 F-7 Pulmonary Function Studies G-1 G-18 Radiology Services Listings G-1 G-3 General Radiology G-4 G-7 Special Procedures G-8 Other Items G-9 G-13 Diagnostic Ultrasound G-13 Therapeutic Ultrasound G-14 G-16 Computed Tomography G-17 Magnetic Resonance Imaging G-18 Interventional Radiology H-1 H-4 Nuclear Medicine Services Listings H-1 Cardiovascular System H-1 Endocrine System H-1 H-2 Gastrointestinal System H-2 Genitourinary System H-2 Hematopoietic System H-3 Musculoskeletal System H-3 Nervous System H-3 Respiratory System H-3 Miscellaneous H-3 SPECT Single Photon Emission Computerized Tomography H-3 Special Visit Premiums H-4 Therapy using Radioisotopes I-1 I-4 Obstetrics Listings I-1 Obstetrical Care I-2 Anaesthesiology I-3 Operative Delivery I-4 Surgical Obstetrics J-1 J-9 Anaesthesia for Surgical Dental Listings J-1 Extractions J-1 Extraction of Impacted Teeth J-1 Surgical Exposure of Teeth J-1 Surgical Movement of Teeth J-1 J-2 Remodelling and

9 Recontouring Oral Tissues J-2 Test, Histological J-2 J-3 Surgical Excisions J-3 Surgical Incisions J-4 Treatment of Fractures J-5 J-6 Treatment of Maxillofacial Deformities June 1, 2013 TABLE OF CONTENTS PAGE CONTENTS vi J-6 J-7 Treatment of Temporomandibular Joint Dysfunctions J-7 Treatment of Salivary Glands J-7 J-8 Neurological Disturbances J-8 Antral Surgery J-8 Haemorrhage Control J-8 Grafts, Surgical J-8 Emergency Procedures J-9 Special Procedures K-1 K5 Surgical Procedures K-1 Surgical Premiums Listing and some description K-2 K-4 Surgical Premiums Morbidly Obese Patients K-5 Special Procedures Listing L-1 L-11 Operations on the Integumentary System L-1 Incision L-2 L-4 Excision L-2 L-3 Excision of Benign Lesions L-4 Excision of Malignant and Premalignant Lesions L-4 L-9 Repair L-10 Plastic Surgery Procedures L-11 Operations on the Breast M-1 M-40 Operations on the Musculoskeletal System M-1 M-2 General Fees M-3 M-8 Hand and Wrist M-9 M-12 Elbow and Forearm M-13

10 M-16 Shoulder/Arm/Chest M-17 M-21 Skull and Mandible M-22 M-25 Spine M-26 M-28 Pelvis and Hip M-29 M-30 Femur M-31 M-33 Knee M