Family doctors are key to BC’s immunization roll-out. We are experts in immunization and experts in reaching our patients, especially those most vulnerable. In order to support our critical role, we have been working with the Medical Services Plan and Doctors of BC to identify appropriate remuneration for COVID-19 immunizations.
We know that administration of COVID-19 vaccines will occur in a range of different locations. At the current time, immunizations are being administered to high-risk populations as identified by BC’s COVID-19 Immunization Plan. Family doctors have already been involved in immunizing residents in long-term care as well as immunizing colleagues who work in settings like long-term care, intensive care units, and emergency departments.
Immunizations in long-term care and other mass immunization settings
Alternate payment funding has been identified for mass immunization settings with payment rates aligned to the FP sessional rate. This contract is available for use via health authorities. Given the billing challenges inherent in mass immunization settings, this payment model is the one that should be utilized.
As this funding has recently been developed, payment processes are still being developed and implemented. If you have been providing immunizations in long-term care or via other health authority operated mass immunization clinics, you can access the funding through your local health authority.
Immunizations done in your clinic and other settings
We know there are increased costs and considerations for providing COVID-19 immunizations. Given that these are a new type of immunization, many patients will require longer visits to discuss vaccine safety, how the vaccines work, and reasons to get vaccinated. Counteracting vaccine misinformation will also require our time and engagement.
As a result of these factors, we have secured three temporary fee codes for COVID-19 immunizations for services provided to patients of all age groups. These are intended to support immunization services in our clinics and other settings that are not health authority-operated mass immunization clinics. Once new fridge-stable COVID-19 vaccines are available, we will likely be billing these frequently. It is important to note, however, that the fee codes are not restricted to any setting or type of vaccine.
The fee codes are effective for dates of service on January 25, 2021 or later. The end date will be determined by the Provincial Health Officer.
Details of the fees
Two of the COVID-19 immunization fees (T10042 and TB10043) are similar to the temporary respiratory immunization fees approved in the fall. These can be used for straight-forward immunization encounters. A third fee was created to account for circumstances where you may need to spend more time with patients, whether that is time spent addressing vaccine hesitancy, educating patients, or managing unique patient needs.
SCENARIO 1: Bill fee code 10042 (using ICD-9 code C19) plus the age-appropriate visit service when the immunization is done with an in-person visit for an unrelated reason (office visit, prenatal visit, counselling, consultation etc).
T10042 COVID-19 immunization (with visit) ………. 5.43
Notes:
i) Payable for COVID-19 immunization (ICD-9 code C19 must be entered on claim).
ii) Payable in full with a visit.
iii) If the primary purpose of the service is for immunization, bill fee item 10043 and 10044 if applicable.
SCENARIO 2: Bill fee code 10043 (using ICD-9 code C19) when the primary purpose of the service is for COVID-19 immunization, if the visit takes 10 minutes or less.
TB10043 COVID-19 immunization (without visit) ……….14.00
Notes:
i) Payable for COVID-19 immunization (ICD-9 code C19 must be entered on claim).
ii) Not payable with a visit.
SCENARIO 3: Bill fee code 10043 and 10044 (using ICD-9 code C19) when the primary purpose of the service is for COVID-19 immunization, if the visit takes more than 10 minutes. This provides total remuneration equal to the 00100 office visit value of $31.62.
TB10043 COVID-19 immunization (without visit) ……….14.00
Notes:
i) Payable for COVID-19 immunization (ICD-9 code C19 must be entered on claim).
ii) Not payable with a visit.
TB10044 Extended COVID-19 immunization (extra)………17.62
Notes:
i) Payable for an extended COVID-19 immunization (ICD-9 code C19 must be entered on claim).
ii) Paid only in addition to 10043 where physician time with the patient exceeds 10 minutes.
iii) Start and end times must be entered in both the billing claim and the patient’s chart.
iv) Not payable for immunizations provided as part of a health authority immunization program.
v) Cannot be delegated to a nurse or other employee of the physician’s practice.
More information about billing for COVID-19 immunizations
If you have further questions about billing for COVID-19 or other immunizations, you can send us a billing question.
Information on billing for all immunizations can be found in our Simplified Fee Guide.
Photo credits: Heather Hazzan, SELF Magazine, and Steve Cornfield on Unsplash