BC’s COVID-19 Immunization Plan is now well underway with additional focus on patients who are clinically extremely vulnerable and living in high-transmission neighbourhoods. With increasing pressures on our hospitals and the ramp-up of vaccination efforts, the relationships that family physicians have with their patients are critical to countering vaccine misinformation and enabling shared-decision making.
Family physicians play an important role in providing information to patients and establishing vaccine confidence. To that end, we are happy to announce a new fee code to support family physicians to provide COVID-19 immunization advice.
This new temporary fee item is effective for dates of service on or after April 15, 2021. The claims system is NOW READY to accept the fee code, so you can submit your billings.
SCENARIO 1: Bill fee code 10045 (using ICD-9 code C19) plus the appropriate visit service when COVID-19 immunization advice is provided with a visit for an unrelated condition (office visit, telehealth visit, prenatal visit, counselling, etc.). The physician time with the patient for the advice must exceed 10 minutes (i.e. minimum of 11 minutes).
Please note: When submitting billings for both immunization advice and a visit for an unrelated reason, start and end times in the billing claim should only be noted for the 10045 immunization advice fee code (not the visit). If immunization advice is provided with a counselling visit, the counselling must meet the criteria for billing counselling and the start/end times for the counselling visit should be noted as different from the times for the 10045.
T10045 COVID-19 immunization advice fee (extra) ………. 17.62
Notes:
i) Payable for COVID-19 immunization advice (ICD-9 code C19 must be entered on claim).
ii) Paid only in addition to a visit for an unrelated condition and is paid in full.
iii) Physician time with the patient for the advice must exceed 10 minutes exclusive of time spent on the base unrelated visit.
iv) Start and end times must be entered in both the billing claim and the patient’s chart.
v) Not payable with a COVID-19 immunization by the same practitioner, same day.
vi) If COVID-19 immunization advice is provided with a visit for an unrelated condition and with a procedure, bill the procedure and 50% of a visit with ICD-9 code C19.
vii) If COVID-19 immunization advice is provided as a stand-alone service, bill the appropriate visit code with ICD-9 code C19.
viii) Cannot be delegated to a nurse or other employee of the physician’s practice.
SCENARIO 2: Bill the appropriate visit service when COVID-19 immunization advice is provided with a visit for an unrelated condition (office visit, telehealth visit, prenatal visit, counselling, etc) when physician time with the patient for the advice is 10 minutes or less. Use the ICD-9 code C19.
SCENARIO 3: Bill the procedure and 50% of a visit (with ICD-9 code C19) when COVID-19 immunization advice is provided with a visit for an unrelated condition AND with a procedure. The COVID-19 immunization advice fee is NOT billable in addition.
SCENARIO 4: Bill the appropriate visit service (office visit, telehealth visit, prenatal visit, counselling, etc) when COVID-19 immunization advice is provided as a stand-alone service. Use the ICD-9 code C19.
SCENARIO 5: Bill the appropriate group medical visit code when COVID-19 immunization advice is provided to a group of patients. Use ICD 9 code C19. Review the fee details to ensure that the visit meets the requirements for group medical visit billing.
More information about providing advice for COVID-19 immunizations
If you have additional questions about billing for COVID-19 immunization advice, send us a billing question.
If you have questions about billing for COVID-19 immunizations, you can view this summary or take a look at the Simplified Fee Guide.
UBC Primary Care Innovation Support Unit’s Primary Care COVID-19 Immunization Toolkit can help you with patient discussions and resources about COVID-19 immunizations and addressing vaccine hesitancy.