Fee-for-Service: Review your c-section billings

BC Family Doctors is advising all family physicians who bill labour and birth care under fee-for-service to review their remittance reports from June to October 2025.

A change in the adjudication process for caesarean section billing led to incorrect payments for many 14109 claims.

• Claims for 14109 Primary management of labour, attendance at delivery, and post-natal care with emergency c-section were refused or downgraded to 14108 Post-natal care after c-section.

• The Ministry of Health has confirmed that the issue has now been corrected.
• Physicians may resubmit claims if the service meets the billing criteria for 14109.

When should 14109 be billed?

14109 should be billed when the physician manages labour and attends the emergency c-section delivery. It also includes payment for postnatal care in hospital.

• While more than one physician may be involved in the patient’s care over multiple call shifts or days, only one 14109 billing claim will be paid per pregnancy.

• If the c-section was elective (planned), 14108 is the correct fee.

When to Resubmit

Resubmit your billing claim when:

• You provided primary management of labour,
• The patient required an emergency C-section which you attended, and
• The original 14109 claim was downgraded to 14108 or refused.

How to Resubmit

1. Resubmit promptly
   • Review and resubmit claims as soon as possible, ideally within 90 days of the original adjudication.
2. Retrieve the Original Claim
   • Note the original claim number and date of service.
3. Use Submission Code “X”
   • Resubmit the claim under fee item 14109 using submission code “X” for reassessment.
4. Add a Claim Note Record
   • Include a brief explanation such as: “Resubmission of 14109 – Managed labour for a patient who intended a vaginal delivery; emergency C-section required.”
5. Ensure Documentation in the Medical Record
   • Chart notes and the Labour & Birth Summary Record should clearly note:
     • Your role as MRP for labour and delivery
     • Labour management details
     • Circumstances of the emergency C-section
     • Postnatal care provided
6. Track your resubmissions
   • Keep a list of resubmitted claims
   • Check for these claims on the following remittance statements
7. Follow-up
   • If claims are not paid in the next 1-2 claim periods, follow-up with HIBC.
   • HIBC may request supporting information after review.
   • Let BC Family Doctors know if there are ongoing payment issues

Questions & Billing Support

Contact HIBC by phone for assistance with claim resubmission:

• Vancouver: (604) 456-6950

• Elsewhere in BC: 1-866-456-6950

Contact billing@bcfamilydocs.ca to:

• clarify 14109 and 14108 fee criteria
• identify ongoing/other issues with obstetrical billing claims.