New Alberta Virtual Care Code Rules

The AMA and AHCIP recently notified physicians about upcoming changes to virtual care codes in Alberta. The changes will better compensate physicians, moving virtual care to a compensation structure more similar to in-person care. In this blog post, we will summarize the changes as they are released from AHCIP.

IMPORTANT: As of the date this blog post was published, the changes to AHCIP’s Claim Assessment System (CLASS) have not yet been made. Claims submitted with complexity modifiers will not be paid correctly. Physicians are requested to hold complex modifier eligible claims with dates of service effective January 1, 2022 and after until further notice. A new Medical Bulletin providing information about the completion of CLASS changes will be issued as soon as possible.

Background

Just prior to January 1, 2022, the AMA shared an updated in which they indicated there would be upcoming changes to the AHCIP Schedule of Medical Benefits (SOMB) that will allow:

  • recognition of indirect patient care time
  • allowing complex modifiers on lengthy visits
  • aligning fees for virtual psychiatric treatment with fees for in-person care
  • reducing time requirements for virtual assessments
  • allowing age modifiers on visits

In the AMA’s letter, they advised physicians to “hold complex modifier eligible claims with dates of service effective January 1, 2022 and after until further notice.”

Bulletin MED 252: Enhanced Virtual Care Codes

On January 12, 2022, AHCIP issued a Medical Bulletin MED 252 (https://open.alberta.ca/dataset/58a224a2-0fed-4b1e-b8d5-9f6cf70450c6/resource/a86552b8-d684-41eb-afbc-27729290950d/download/health-ahcip-bulletin-med-252-2022-01-12.pdf). This bulletin confirm the AMA’s letter and provider further details on the changes as summarized below:

  • Effective Date of Changes: The following changes made to virtual care codes will be retroactive to January 1, 2022
  • Time spent on Indirect Care for Patients: Physician provided indirect care/patient management services that are related to the provision of an insured service may be included in the time calculations for virtual services. This means the time spent reviewing patient charts, completing referrals, etc. may count toward the time requirements. In order to be eligible to claim for patient management time, all services must have been completed on the same date of service as the patient virtual visit; only physician time can be claimed.
  • Allowance of Complex Modifiers on Virtual Care Codes: Physicians will be allowed to bill a single complex modifier for eligible virtual visits and consultations. The following table provides further details regarding these changes

Summary of Virtual Care Code Changes by Code:

Topic Virtual Care HSC(s) Eligible Specialties Change
Indirect Care
/Patient
management
services
03.01AD
03.03CV
03.03FV
03.08CV
All physicians who provide both inperson and virtual care as a part of
their practice
Time spent on patient
management services can be
counted towards the time
requirements for relevant virtual
care HSCs.
Complex Modifier 03.03CV [1] Family physicians meeting criteria. May bill CMGP01 for a virtual
limited assessment when the total
time spent providing patient care
is at least 15 minutes (No
additional calls of CMGP are
allowed).
03.03CV [2] Specialists meeting criteria from
the following specialty groups:
• Community medicine
• Geriatric medicine
• Occupational medicine
• Radiation oncology
• Cardiology
• Endocrinology/metabolism
• Hematology
• Infectious diseases
• Internal medicine
• Medical oncology
• Nephrology
• Pediatrics
• Pediatric cardiology
• Rheumatology
May bill CMXV15 for a virtual
limited assessment when the total
time spent providing patient care
is at least 15 minutes.
03.03CV All remaining specialties not listed
above i.e. [1] & [2].
May bill CMXV20 for a virtual
limited assessment when the total
time spent providing patient care
is at least 20 minutes.
03.03FV Specialists meeting criteria from the
following specialty groups:
• Cardiology
• Endocrinology/metabolism
• Hematology
• Infectious diseases
• Internal medicine
• Medical oncology
• Nephrology
• Pediatric cardiology
• Pediatrics
• Rheumatology
May bill CMXV15 for a virtual
follow-up assessment when the
total time spent providing patient
care is at least 15 minutes
(referred cases only).
03.03FV Specialists meeting criteria from the
following specialty groups:
• Clinical immunology
• Critical care medicine
• Gastroenterology
• Medical genetics
• Neurology
• Neonatal perinatal medicine
• Pediatric gastroenterology
• Pediatric neurology
• Pediatric nephrology
• Physical medicine
• Respiratory medicine
• Urology
• Vascular surgery
May bill CMXV20 for a virtual
follow-up assessment when the
total time spent providing patient
care is at least 20 minutes
(referred cases only).
03.08CV All physicians meeting criteria for
referred cases only.
May bill CMXC30 for a virtual
consultations when the total time
spent providing patient care is at
least 30 minutes.

Other Important Notes

  • Virtual Care codes are not covered by the medical reciprocal agreement. Claims for virtual services are not payable for services provided to patients with out-of-province (OOP) health care coverage. That said, Statgo has been able to get some of these OOP claims paid through alternate submission methods. Please submit your OOP virtual care code claims and Statgo will make best efforts to obtain payment for you. 
  • As of the date this blog post was published (January 14, 2022), the changes to AHCIP’s Claim Assessment System (CLASS) have not yet been made. Claims submitted with complexity modifiers will not be paid correctly and if submitted, will need to be resubmitted for reassessment at a later date. To avoid this, physicians are requested to hold complex modifier eligible claims with dates of service effective January 1, 2022 and after until further notice. A new Medical Bulletin providing information about the completion of CLASS changes will be issued as soon as possible.