September 13, 2021 - gnb.ca

1 May 18, 2017 TABLE OF CONTENTS NUMERIC INDEX .. 14 CHAPTER 1: GENERAL MEDICARE INFORMATION .. 33 Section 1: Conditions of Participation .. 33 Definition of a Practitioner .. 33 Participating Practitioner .. 33 Procedure to become a non-participating practitioner .. 33 Opted Out 33 Conditions Regarding Submission and Payment of Claims .. 34 Opted-in practitioners .. 34 Information to patients regarding opted-out status .. 34 Participating Physician s Agreement .. 34 Claims Submission and Payment 35 Required Information Electronically Submitted Claims .. 35 Required Information Paper Claims Submitted .. 36 Time Limit for Submission of Claims .. 37 Submission of Claim Form .. 37 Submission of claims opted-out services.

2 39 Residents of other countries .. 39 Residents of other provinces .. 39 Non-resident claim form .. 39 Services Excluded Under the Interprovincial Agreements for Processing .. 40 Payment of Claims .. 40 Payment to practitioners .. 40 Adjustment to claims .. 40 Patient identification .. 41 Procedure if patient is not registered .. 41 Prior Approval .. 41 Section 2: Appeal Procedures .. 42 Appeals by Physician .. 42 Appeals by beneficiaries .. 42 Section 3: Excluded 42 Section 4: Supplies and Materials .. 44 44 Excluded .. 44 Section 5: Patient Eligibility and Registration .. 45 Section 6: Forms .. 45 Section 7: Monitoring and Compliance .. 45 General Information .. 45 Records standards .. 45 Interval .. 46 On-site Visits .. 46 Verification Letters .. 46 46 Professional Review Committee.

3 46 CHAPTER 2: ASSESSMENT RULES .. 47 Section 1: Basis of Payment .. 47 Assessment Rules General .. 47 Assessment Rules Details .. 47 CHAPTER 3: GENERAL PREAMBLE .. 52 Section 1: Introduction .. 52 Principles of Billing .. 52 Terms and 53 Specialist .. 53 Visit .. 53 Examination .. 55 56 Obstetrical Services .. 60 Paediatric services .. 60 Surgical services .. 60 Referred and transferred patients .. 60 Anaesthetic Services .. 61 Independent Consideration .. 61 New Services 62 Iatrogenic Injuries .. 63 Detention Fees .. 63 Laboratory Services .. 63 Disputed Fees .. 63 Revision of Schedule .. 63 Unit Values .. 64 Sessional 65 65 Abbreviations .. 65 CHAPTER 4: ITEMS COMMON TO ALL PRACTITIONERS .. 66 Section 1: Uninsured 66 Industrial and public health medicine or other services at the request of a public 66 Blood alcohol samples and documentation at the request of the Department of Public Safety.

4 66 Visit and 66 Blood samples and documentation .. 66 Detention .. 66 Section 2: Miscellaneous 67 Nursing Homes .. 67 Emergency Visits .. 67 Visits to hospital emergency or outpatient departments .. 68 Detention Fee .. 69 Surgical Assistance fee Role 3 .. 70 Explaining the need for a second assistant .. 70 Collaborating Surgery Role 6 .. 71 Concurrent Care .. 71 Directive Care .. 71 Continuing Care .. 71 Supportive Care .. 71 Transfer of Care .. 71 Sessional fees .. 72 Special Care 72 Miscellaneous Services .. 73 Total Parenteral Nutrition (hyperalimentation) .. 74 After Hours Emergency Premium .. 74 Information Table Re: Claiming IC / Cancer / Emergency Premium .. 76 Service Codes Eligibile for AHEP Under Conscious Sedation .. 77 Cancer 79 Surgical Obesity Premium.

5 79 Miscellaneous Visit Fees .. 80 Extramural Program .. 80 Counseling .. 80 Home Visits .. 81 Extended care/restorative care .. 82 Reassessment for Chemotherapy .. 83 Initial Management of multiple systems trauma .. 83 Attendance During Transport .. 83 Attendance Fees Victims of Alleged Sexual Assault .. 83 Organ Donor Maintenance Fee .. 84 Injections .. 84 84 Surgical Prioritization Tool Completion .. 86 Telemedicine .. 86 Rural Health Care .. 88 Travel Stipend .. 88 New Brunswick Medicare On-Call Programs .. 89 Mandated On Call / Second Call Program .. 91 Mandated On-Call Rotations .. 96 Province-Wide On-Call Program .. 97 CHAPTER 5: SPECIALTIES .. 100 Section 1: General Practice .. 100 100 Office Visits .. 100 Hospital Care .. 104 Outpatient Department Scheduled Visits.

6 106 Home Visits .. 106 Visit to vessel .. 107 Post-mortem examination .. 107 Obstetrical care .. 107 Newborn Care .. 107 Psychotherapy .. 108 Anaesthesia fees .. 108 Telemedicine .. 108 Section 2: Services in Anaesthesia .. 109 Anaesthetic Services Preamble .. 109 Modifying Units .. 110 Special Procedures .. 111 Consultations and Visits .. 112 Hospital Care .. 112 Outpatient Department Scheduled Visits .. 113 Intensive Care .. 113 Section 3: Specialists in Cardiac Surgery .. 115 115 Hospital Care .. 115 Outpatient Department Scheduled Visits .. 116 Directive Care .. 116 Other Visit Fees .. 116 Section 4: Specialists in Dermatology .. 117 117 Office Visits .. 117 Hospital Care .. 117 Outpatient Department Scheduled Visits .. 118 Home Visits .. 118 Dermatological Procedures.

7 118 MOHS Micrographic 119 Section 5: Specialists in General Surgery .. 120 120 Office Visits .. 120 Hospital Care .. 120 Outpatient Department Scheduled Visits .. 121 Home Visits .. 121 Initial Management of Multiple Systems Trauma .. 122 Section 6: Specialists in General Internal Medicine .. 123 123 Office Visits .. 123 Hospital Care .. 123 Outpatient Department Scheduled Visits .. 124 Directive Care .. 124 Other Visit Fees .. 124 Section 7: Specialists in Internal Medicine .. 125 125 Office Visits .. 125 Hospital Care .. 125 Outpatient Department Scheduled Visits .. 126 Home Visits .. 126 Intensive Care .. 127 Pacemaker .. 127 Section 8: Specialists in Laboratory Medicine .. 128 Outpatient Department Scheduled Visits .. 128 Miscellaneous .. 128 Section 9: Specialists in Neurology.

8 129 129 Office Visits .. 129 Hospital Care .. 129 Outpatient Department Scheduled Visits .. 130 Home Visits .. 130 Intensive Care .. 130 Special Procedures .. 131 *Botulinum Toxin Injection .. 131 Section 10: Specialists in Neurosurgery .. 133 133 Office Visits .. 133 Hospital Care .. 133 Outpatient Department Scheduled Visits .. 134 Intensive Care .. 134 Section 11: Specialists in Obstetrics and Gynaecology .. 135 135 Office Visits .. 135 Outpatient Department Scheduled Visits .. 136 Home Visits .. 136 Obstetrical Care .. 136 Gynecology Procedures Add-on fee .. 137 Section 12: Specialists in Ophthalmology .. 138 138 Office Visits .. 138 Procedures .. 138 Hospital Care .. 139 Outpatient Department Scheduled Visits .. 140 Home Visits .. 140 Visual Fields.

9 140 Computerized Visual Fields .. 140 Ultrasound - Eye .. 140 Contact Lens Fitting .. 141 Heidelberg Retinal Tomography (HRT) .. 141 Section 13: Specialists in Orthopaedic Surgery .. 142 142 Office Visits .. 142 Hospital Care .. 142 Outpatient Department Scheduled Visits .. 143 Home Visits .. 143 Section 14: Specialists in Otolaryngology .. 144 144 Office Visits .. 144 Hospital Care .. 144 Outpatient Department Scheduled Visits .. 145 Home Visits .. 145 Intra Tympanic Injection of Medication .. 145 Special Examination .. 146 Electronystagmography .. 146 Tonsillectomy +/- adenoidectomy .. 147 Botulinum Toxin Injection .. 147 Section 15: Specialists in Paediatrics .. 148 148 Office Visits .. 148 Injections .. 148 Hospital Care .. 148 Premature 149 Outpatient Department Scheduled Visits.

10 150 Home Visit .. 150 IntensiveCare .. 150 Special Procedures .. 150 Section 16: Specialists in Physical Medicine and Rehabilitation .. 152 152 Office Visits .. 152 Hospital Care .. 152 Outpatient Department Scheduled Visits .. 153 Home Visits .. 153 Miscellaneous .. 153 Special Procedures .. 153 Botulinum Toxin Injection .. 154 Section 17: Specialists in Plastic Surgery .. 155 155 Office Visits .. 155 Hospital Care .. 155 Outpatient Department Scheduled Visits .. 156 Home Visits .. 156 Team Procedures Major Complex Reconstruction Surgery .. 156 Section 18: Specialists in Psychiatry .. 158 158 Office Visits .. 158 Outpatient Department Scheduled Visits .. 159 Home Visits .. 160 Other Procedures .. 160 Section 19: Specialists in Respirology .. 161 161 Office Visits.