Changes to Telehealth and Telephone Services
No, the change applies to all services by family doctors that can be safely and appropriately provided by video or phone. If you provide a service related to COVID-19, please use diagnostic code C19.
The new temporary age adjusted fee codes are effective June 1, 2020. If the previous codes are used on June 1 or later, they will be rejected.
Bill the following codes for a Telehealth Visit (0100-series equivalent), regardless of your location (home, office or Health Authority approved facility).
Bill the following codes for Telehealth Counselling (0120-series equivalent), regardless of your location (home, office or Health Authority approved facility).
**Submission of fee codes 13038 and 13018 with dates of service on or after June 1 will be rejected.
i ) MSP will pay for up to four (4) individual counselling visits (any combination of age appropriate in office, out of office, and telehealth) per patient per year (see Preamble D. 3. 3.)
ii) Start and end time must be entered into both the billing claims and patient’s chart.
iii) Documentation of the effect(s) of the condition on the patient and what advice or service was provided is required.
Bill the following codes for Telehealth Consultations (0110-series equivalent), regardless of your location (home, office or Health Authority approved facility).
**Submission of fee codes 13036 and 13016 with dates of service on or after June 1 will be rejected .
The COVID-19 pandemic has resulted in Telehealth delivery for the majority of services done by family doctors, and Telehealth is expected to remain a significant part of care delivery for the foreseeable future.
Values of the previous GP telehealth visit (13037), counselling (13038) and consultation fees (13036) are set at the weighted average of the in-person 0100, 0120 and 00110 series, respectively. These fee code series were age-adjusted years ago as there is good evidence that age is a reasonable proxy for population-level complexity (though there are many individual exceptions).
By changing the Telehealth fees to match their in-office versions, patient services will be remunerated the same amount, regardless of whether the care is delivered in-person or via Telehealth.
Bottom line, as of June 1st:
Why are the new June 1st Telehealth fees the same for all locations (both in and out of health authority facilities)?
When these Telehealth fees were originally developed years ago, the definition of a Telehealth service included video only. At the time, available technology required community-based physicians to leave their office to go to a health authority site to access the Provincial Telehealth Network. Later, modifications to the fees were made to differentiate services that required the physician to attend a health authority facility, and those provided from office or home.
The June 1st temporary pandemic-related changes to age-adjusted Telehealth fees eliminates the two levels of payment for services delivered in and out of health authority facilities. With the advent of modern video platforms (and now with expansion to telephone during the duration of the pandemic), leaving the office/home to go to a health authority site to provide Telehealth services is rarely necessary.
When using the new age-adjusted Telehealth fee codes (13237 series and 13238 series), do I have to include a claim note record that the service was provided by Telehealth?
Non-procedural interventions provided by video or telephone where there is no Telehealth fee should be billed under the equivalent face-to-face fee with a claim note record stating the service was provided via Telehealth.
Some examples of non-procedural interventions provided by family physicians for which there is no Telehealth fee code include prenatal visits (14091); HIV primary care management (13015); OAT assessment and management of induction and maintenance of OAT (13013, 13014, 00039). Submission must include a claim note record stating the service was provided via Telehealth.
No. The 0101 series fee codes require an in-person physical examination.
The 13237 series like the 0100 series does not require start end times. The 13238 series codes are counselling visits and must meet the same definition of counselling and time requirements as the 0120 series. For 13238 series billings, start and end times must be submitted with the billing and noted in the medical record.
If I determine, as a result of a Telehealth visit, that I need to see the patient in-person the same day for a physical exam, what do I bill?
You bill either the age-appropriate 13237 series for the telephone visit OR the appropriate in-person fee for the face-to-face visit. Telehealth and an in-person service are not billable on the same patient/same day by the same physician.
My multi-physician clinic is dividing the work load during the COVID-19 Pandemic. If I provide a Telehealth visit with my patient and determine they need to be seen in-person that day at our clinic by a different physician, how does each physician bill?
The age-appropriate 13237 series code for the telephone visit is billable by the first physician, and the appropriate in-person fee for the service provided in-person is billable by the other physician.
If a colleague determines via a Telehealth visit that the patient requires a physical examination, and I am the physician providing the in-person assessment, can I bill a GP consultation (00110 series)?
No. This does not meet the requirements for a GP Consultation (00110 series) as defined in the MSC Payment Schedule.
I delegate some phone calls to my office nurse and bill 14076. Can these now be billed as telehealth visits using the age appropriate 13237 series?
If a Telehealth visit with the patient is necessary to determine if a prescription renewal is appropriate or a different prescription is necessary, then bill the age-appropriate 13237 series code (as you would do for seeing the patient in person and billing the 0100 series.)
If you are doing a prescription renewal without seeing the patient (either virtually or in person), you may now bill T13707 FP Email/Text/Telephone Medical Advice Relay or ReRX Fee in the amount of $7.
I provide consultations by referral for my colleagues’ patients – can I now do this using Telehealth (video or telephone) instead?
If you feel you could have provided an in-person consultation without a physical examination, then you may use Telehealth for the consultation without an examination and bill the age appropriate Telehealth GP consultation fee (13236 series).
Continue to use your professional judgement to determine whether use of virtual technology is clinically appropriate, considering the circumstances of each patient.
What is the difference between a Telehealth visit (13237 series) and a Telehealth consultation (13236 series)?
Telehealth consultation fees (13236 series) are for consultation services provided by referral only and must meet the Preamble definition of a GP in-person consultation, excepting the requirement for physical examination.
Yes, if you are able to use a video platform or teleconference line that allows all patients to attend, bill the visit under the applicable Group Medical Visit code with a claim note record “service provided via Telehealth.”
Remember that group medical visits require a 1:1 interaction between each patient and the attending physician.
Group counselling has its own specific Telehealth fee codes: 13041 and 13042.
Can I bill Telehealth counselling (13238 series) for advance care planning and goals of care discussions in light of COVID-19?
The 13238 series must meet the same criteria as 0120 series. The General Preamble states:
“Counselling is defined as the discussion with the patient, caregiver, spouse or relative about a medical condition which is recognized as difficult by the medical profession or over which the patient is having significant emotional distress,…”
Discussing advance care planning in the context of COVID is recognised as difficult by all physicians, and many patients will also be experiencing significant emotional distress. Some conversations about advance care planning, goals of care discussions, and Medical Orders for Scope of Treatment (MOST) designations will take 20 minutes or longer and can be billed using the age appropriate 13238 series codes. The visit must be a minimum of 20 minutes and start/end times are required to be recorded in the chart and submitted with the claim. Shorter visits should be billed using age appropriate 13237 series codes.
Other opportunities for advance care planning occur when creating a care plan as part of any GPSC planning visit (Complex Care 14033 and 14075, Mental Health 14043 and Palliative 14063.) During these visits, it is expected that advance care planning occurs (when clinically appropriate) and is documented in the care plan. Remember that the required face to face physician: patient planning time may now be provided by Telehealth during the COVID-19 pandemic.
What about the care of patients who need opioid agonist treatment (OAT)? These patients still need care.
Bill the age-appropriate 13237 series code using the child’s PHN. You may not bill an additional Telehealth visit simply for talking to the parent about the child’s condition. However, if the parent also has a medical problem that you address during the same encounter, then it would be appropriate to bill the age-appropriate 13237 series code for the service to the parent.
If I provide Telehealth visits outside of usual office hours or on weekends is there an out-of-office hours fee I can bill in addition?
Daily Volume Payment Limits have been suspended during the pandemic.
I’ve heard that I have to include a claim note record when submitting claims for services provided by Telehealth? What does that mean?
However, if you are billing an in-person fee code because there is no specific Telehealth code for the service, you must include a claim note record that the service was provided via Telehealth. You must also note this in the medical record.
The Business Cost Premium (BCP) will be temporarily expanded to apply to in-office telehealth fee items during the COVID-19 pandemic. This is effective May 1, 2020 (not retroactive).
How do I submit my Telehealth billings to ensure that they receive the Business Cost Premium (BCP)?
Eligible BCP claims require submission of the unique facility number you received when you registered for the BCP as well as location code A, which identifies Practitioner’s office – in community. The appropriate facility number and service location code is based on where the service would have been provided if it had been performed face-to-face.
Check your EMR to make sure the facility number and location code come up when telehealth fees are billed. If not, you or your MOA will have to manually add the codes for each billing or hold the billings until your EMR is updated.
Remember: In order to receive the BCP, physicians need to register their facility (clinic) and attach themselves as a practitioner of the facility.
You can read more about the BCP, including eligible fees, payment details and the registration process here.
Yes. If your patient has recently moved from another province and is not yet enrolled with MSP, bill Telehealth fees in the same way that you would bill in-person fees, using their previous out of province address and health number.
Note for physicians practicing in a border community:
From the CPSBC Practice Standard on Telemedicine: The requirements for treating patients via telemedicine vary by jurisdiction. Physicians must be aware of and comply with the licensing requirements in British Columbia, and in the province/territory where the patient is located. Some jurisdictions require physicians to hold a licence in order to treat a patient located in that jurisdiction.
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