Medical Payment Schedule - Newfoundland And Labrador
mcpMedical Care PlanMedicalPaymentScheduleMedical Care PlanDepartment of Health & CommunityServicesOctober 1, 2019
October 1, 2019TABLE OF CONTENTSPAGECONTENTSA-1Payment Schedule IdentificationChanges, etc. to the Payment ScheduleEffective Date of Listed ServicesNLMA InvolvementA-1 – A-4Payment Schedule Layout with descriptions of each section of the Scheduleas follows:Listing of the SectionsGeneral PreambleAppendicesVisit PremiumsConsultations and VisitsTelemedicineCritical CareDiagnostic and Therapeutic ServicesIn-Hospital Diagnostic and Therapeutic ServicesRadiologyNuclear MedicineObstetricsAnaesthesia for Surgical-Dental ProceduresSurgical ProceduresTablesA-5 – A-6Insured/Non-Insured Services, with divisions as follows:Insured ServicesNon-Insured ServicesCommon Elements of Insured ServicesA-7 – A-9Claim Submission RulesDocumentation RequirementsMinimum Required Documentation for ClaimsIndependent Consideration SubmissionProvider Billing NumberTime Limitations on Claim SubmissionA-10 – A-13A-10 – A-11Definitions of Terms/ConditionsSite of Insured Service, with some rules regarding each, as follows:OfficeHomeHospital In-PatientHospital Out-Patient and Emergency DepartmentVisits to Other SitesA-11 – A-12A-12A-13Delegated ProceduresAge (of Patients) DefinedMost Responsible Physician DefinedReferral and Transferral DefinedRules re TransferralsTeam Care in Teaching Unitsi
October 1, 2019TABLE OF CONTENTSPAGECONTENTSA-14 – A-18A-14A-14A-14 – A-15A-15 – A-18ConsultationsConsultations DefinedDocumentation of ConsultationsRules Applicable to ConsultationsMajor Consultations – Defined and with rules specific to eachA-19 – A-32Definitions and Rules for each visit type, other than consultations, listed in alphabeticalorder of first letter of the visit name as listed in the Visits Section.A-33 – A35Critical Care Section of the Schedule described, giving the rules for billing from it.A-36 – A37Diagnostic and Therapeutic Procedures Section of the Schedule described, giving therules for billing from it.A-38In-Hospital Diagnostic Procedures Section of the Schedule described, giving the rulesfor billing from it.A-39 – A-41Radiology Section of the Schedule described, giving the rules for billing from it.A-42Nuclear Medicine Section of the Schedule described, giving the rules for billing from it.A-39 – A-54A-39 – A-42A-43A-44 – A-46A-47 – A-48A-49A-49 – A-50A-50A-51 – A-54Specific Rules for BillingRadiology/Nuclear Medicine ServicesObstetric ServicesSurgical Procedures, generallyFracture CareSurgical Assist – Standard MethodSurgical Assist – Dedicated Time MethodSpecialist AssistantAnaesthesiology ServicesA-55 – A-57A-55 – A-57A-55 – A-56A-56 – A-57A-57PremiumsGeneral Rules for Billings Premiums, Both Visit and ProcedureSpecific Rules for Billing Visit PremiumsSpecific Rules for Billing Procedure PremiumsSpecific Rules for Billing Delivery PremiumsA-58 – A-59A-58A-58 – A-59A-59Specific Rules for Billing Sessional Arrangements, listed as follows:General Policy for all Sessional ArrangementsRules Specific to Organized Sessional Clinics and Institutional CareRules Specific to On-Site Emergency Department Coverage –CategoryFacilitiesRules Specific to Dedicated On-Site 24-Hour ICU Sessional CoverageA-59A-60Specific Rules for Billing for Emergency Department Coverage by Family Physicians– Category ‘B’ FacilitiesA-61Specific Rules for Billing Long Term Care Facility Coverage by Family PhysiciansA-62 – A-63Rural Family Physician Hospital PremiumA-64Physician RegistrationA-64Locum Coverageii
October 1, 2019TABLE OF CONTENTSPAGECONTENTSA-65Appendix A – Category ‘A’ Approved Facilities for 24-Hour On-Site EmergencyDepartment CoverageA-66Appendix B – Category ‘B’ Approved Facilities for 24-Hour EmergencyDepartment CoverageA-67Appendix C – DHCS Designated Long Term Care Facilities with Long Term BedsA-68 – A-69Appendix D – Immunization of Designated Target PopulationsA-70Appendix E – Non-Insured Services ListA-71Appendix F – Scar RevisionA-72Appendix G – Hyperbaric Oxygen TherapyB-1 – B-2B-1B-1B-1B-2Visit Premiums ListingOfficeHomeHospital In-PatientHospital Out-Patient and EmergencyC-1 – C-30C-1 – C-5C-6C-7C-8C-9C-10C-11C-12C-13C-14C-15C-16 – C-17C-18C-19C-20 – C-21C-22 – C-23C-24C-25C-26 – C-28C-29C-30Visit Listings by Specialty, beginning with Family Medicine,Family MedicineAnaesthesiologyDermatologyEmergency Medicine SpecialistGeneral, Cardiac, Vascular or Thoracic SurgeryInternal MedicineNuclear Medicine SpecialistDevelopmental NeurologyNeurology (except Developmental Neurology)NeurosurgeryObstetrics and Gynecology and Gynecological OncologyOphthalmologyOrthopaedic SurgeryOtolaryngologyPaediatrics (except Developmental Paediatrics)Developmental PaediatricsPhysical MedicinePlastic SurgeryPsychiatryUrologyRadiologyC-31C-31C-31C-32 – C-49C-32C-33Telemedicine PreambleGeneral PolicyTerms and ConditionsTelemedicine Consultations and ReassessmentsFamily MedicineDermatologyiii
October 1, 2019TABLE OF 43C-44C-45C-46C-47C-48C-49C-50 – C-52CONTENTSGeneral SurgeryInternal MedicineNuclear MedicineDevelopmental NeurologyNeurologyNeurosurgeryObstetrics and aediatricsDevelopmental PaediatricsPhysical MedicinePlastic SurgeryPsychiatryUrologyAppendix H – Approved Telemedicine SitesD-1 – D-3D-1D-2D-3D-3Critical Care ListingNeonatal Intensive CareICU and CCUCardio-Pulmonary ResuscitationProvincial Perinatal High Risk UnitE-1 – E-23E-1E2 – E-3E-4E-5 – E-9E-10E-11E-12E-12E-13E-13E-14 – E-16E-17E-17 – E-19E-20E-21E-22E-22E-22E-23Diagnostic and Therapeutic Services ic Oxygen ogy and MetabolismGastroenterologyFamily MedicineGynecologyInjections or cal MedicinePsychiatryUrologyVenipunctureClinical Procedures Associated with Diagnostic Radiological ExaminationsF-1 – F-7F-1F-1F-1F-1F-2In-Hospital Diagnostic and Therapeutic Services ListingsElectrocardiogramsElectromyography and Nerve ConductionElectroencephalographySleep Apnea StudiesEvoked Potential Studiesiv
October 1, 2019TABLE OF CONTENTSPAGEF-2F-3 – F-4F-4F-5F-5F-6 – F-7CONTENTSDermatologyObstetrics and GynecologyOphthalmologyOrganized Pain ClinicOtolaryngologyPulmonary Function StudiesG-1 – G-18G-1 – G-3G-4 – G-7G-8G-9 – G-13G-13G-14 – G-16G-17G-18Radiology Services ListingsGeneral RadiologySpecial ProceduresOther ItemsDiagnostic UltrasoundTherapeutic UltrasoundComputed TomographyMagnetic Resonance ImagingInterventional RadiologyH-1 – H-4H-1H-1H-1 – H-2H-2H-2H-3H-3H-3H-3H-3H-3H-4Nuclear Medicine Services ListingsCardiovascular SystemEndocrine SystemGastrointestinal SystemGenitourinary SystemHematopoietic SystemMusculoskeletal SystemNervous SystemRespiratory SystemMiscellaneousSPECT – Single Photon Emission Computerized TomographySpecial Visit PremiumsTherapy using RadioisotopesI-1 – I-4I-1I-2I-3I-4Obstetrics Services ListingsObstetrical CareAnaesthesiologyOperative DeliverySurgical ObstetricsJ-1 – J-9J-1J-1J-1J-1J-1 – J-2J-2J-2 – J-3J-3J-4J-5 – J-6Anaesthesia for Surgical Dental ProceduresExtractionsExtraction of Impacted TeethSurgical Exposure of TeethSurgical Movement of TeethRemodelling and Recontouring Oral TissuesTest, HistologicalSurgical ExcisionsSurgical IncisionsTreatment of FracturesTreatment of Maxillofacial Deformitiesv
October 1, 2019TABLE OF CONTENTSPAGEJ-6 – J-7J-7J-7 – J-8J-8J-8J-8J-8J-9CONTENTSTreatment of Temporomandibular Joint DysfunctionsTreatment of Salivary GlandsNeurological DisturbancesAntral SurgeryHaemorrhage ControlGrafts, SurgicalEmergency ProceduresSpecial ProceduresK-1 – K5K-1K-2 – K-4K-5Surgical ProceduresSurgical Premiums Listing and some descriptionSurgical Premiums – Morbidly Obese PatientsSpecial Procedures ListingL-1 – L-11L-1L-2 – L-4L-2 – L-3L-4L-4 – L-9L-10L-11Operations on the Integumentary SystemIncisionExcisionExcision of Benign LesionsExcision of Malignant and Premalignant LesionsRepairPlastic Surgery ProceduresOperations on the BreastM-1 – M-40M-1 – M-2M-3 – M-8M-9 – M-12M-13 – M-16M-17 – M-21M-22 – M-25M-26 – M-28M-29 – M-30M-31 – M-33M-34 – M-35M-36 – M-40Operations on the Musculoskeletal SystemGeneral FeesHand and WristElbow and ForearmShoulder/Arm/ChestSkull and MandibleSpinePelvis and HipFemurKneeFibula and TibiaFoot and AnkleN-1 – N-7N-1 – N-2N-2 – N-3N-3N-4N-5N-6 – N-7Operations on the Respiratory SystemNoseAccessory Nasal SinusesLarynxTrachea and BronchiChest Wall and MediastinumLungs and PleuraO-1 – O-7O-1O-1 – O-3O-3 – O-6O-6 – O-7Operations on the Cardiovascular SystemGeneral FeesHeart and PericardiumArteriesVeinsvi
October 1, 2019TABLE OF CONTENTSPAGECONTENTSP-1P-1P-1P-1Operations on the Haemic and Lymphatic SystemSpleen and MarrowLymph ChannelsLymph NodesQ-1 – Q-16Q-1Q-1Q-2Q-2Q-2Q-3Q-3 – Q-4Q-4 – Q-5Q-5 – Q-6Q-7 – Q-9Q-9Q-9Q-9 – Q-10Q-11Q-12Q-13Q-14Q-15 – Q-16Operations on the Digestive SystemMouthLipsTongueTeeth and GumsPalate and UvulaSalivary Glands and DuctsPharynx, Adenoids and TonsilsOesophagusStomachIntestines (except Rectum)Meckel’s Diverticulum and the MesenteryAppendixRectumAnusLiverBiliary TractPancreasAbdomen, Peritoneum and OmentumR-1 – R-7R-1 – R-2R-3R-4 – R-5R-6 – R-7Operations on the Urogenital SystemKidneys and PerinephrumUreterBladderUrethraS-1 – S-4S-1S-2S-2S-2S-3S-3S-3S-3S-4Operations on the Male Genital SystemPenisTestisEpididymisTunica VaginalisScrotumVas DeferensSpermatic CordSeminal VesiclesProstateT-1 –T-5T-1T-2T-3T-3T-3 – T-5Operations on the Female Genital SystemVulvaVaginaFallopian TubeOvaryUterus and Cervix Uterivii
October 1, 2019TABLE OF CONTENTSPAGECONTENTSU-1U-1U-1Operations on the Endocrine SystemThyroid GlandParathyroid, Thymus and Adrenal GlandsV-1 – V-7V-1 – V-3V-3V-4V-4V-4V-4V-4 – V-5V-5V-6V-6 – V-7Operations on the Nervous SystemBrainSkullOrbitPituitaryCarotid and Vertebral ArteriesCSF Shunting ProceduresCranial NervesPeripheral NervesAutonomic Nervous SystemSpinal Cord and Nerve RootsW-1 – W-9W-1 – W-6W-1W-1 – W-2W-2W-2W-2W-3W-3W-3W-4W-4 – W-5W-6W-6W-7 – W-9W-7W-8W-9W-9Operations on Organs of Special SensesEyeEyeballCorneaScleraIris and Ciliary BodyCrystalline LensVitreousRetinaExtraocular MusclesOrbitEyelidsConjunctivaLacrimal TractEarExternal EarMiddle EarInner EarAcoustic NerveX-1 – X-9X-1X-2X-3X-4X-5 – X-7X-8X-9TablesI – Anaesthesia Basic Fee Code RatesII – Anaesthetic Time Units – Surgical ProceduresIII – Epidural Anaesthesia for Pain ControlIV – SHVs – Type 2V – SHVs – Type 3 and Type 4VI – Surgical Assistants Time Units – Standard MethodVII – Surgical Assistants Time Units – Dedicated Time Methodviii
October 1, 2019GENERAL PREAMBLE1.This Payment Schedule identifies the amounts prescribed as payable and rules and conditions ofpayment under the Physicians and Fee Regulations (Schedule A), governed by the Medical CareInsurance Act for insured services rendered by licensed physicians. The items and fees listedapply to services rendered on and after the “effective date” at the top of each page.The amounts published in Payment Schedule are subject to existing payment policies authorizedby the Medical Care Plan (MCP).Additions, deletions and changes to be made to the Payment Schedule require recommendationby MCP and approval by the Minister of Health and Community Services, in consultation with theNewfoundland and Labrador Medical Association (NLMA).Any changes made during the effective life of the Payment Schedule are published in MCPNewsletters when necessary. It is the responsibility of claiming physicians to ensure thesechanges are reflected in their billings.A-1
October 1, 2019GENERAL PREAMBLE2.INTRODUCTIONThe Payment Schedule is divided into a number of sections:2.1 General Preamble Appendices Visit Premiums Consultations and Visits Telemedicine Critical Care Diagnostic and Therapeutic Services In-Hospital Diagnostic and Therapeutic Services Radiology Nuclear Medicine Obstetrics Anaesthesia for Surgical-Dental Procedures Surgical Procedures TablesGeneral PreambleThis section sets out the general definitions and constituent elements common to all insuredservices, as well as the specific elements for these services.2.2AppendicesThis section gives listings referred to within the Preamble. These are:2.3 Approved Category “A” Facilities – 24-Hour On-Site Emergency Department Coverage Approved Category “B” Facilities – Emergency Department Coverage DHCS Designated Long Term Care Facilities With Long Term Beds Immunization of Designated Target Population Non-Insured Services List Scar Revision Hyperbaric Oxygen TherapyVisit PremiumsThis section lists the rates and conditions for the billing of premium fees associated with specialvisits.A-2
October 1, 2019GENERAL PREAMBLE2.4.1Consultations and Visits(a)Visit codes are listed for each of the specialties, beginning with Family Medicinefollowed by a listing for each of the recognized specialty groups. One letter, usually thefirst letter in each visit code title, is underlined and printed in boldface type, and this lettercorresponds to the first letter in the title of the definition/description of the servicecontained in Section 7 of the Preamble, which is an alphabetical listing.(b)For specialty groups, rates are listed for referred patients. Specialists treating “walk-in” or“non-referred” patients should bill for services rendered to such patients using the ratesfor comparable services as listed in the Family Medicine Section.(c)Each Consultation and Visit Section is divided into sub-sections based on the site wherethe insured service is rendered. Namely: Office (or visit to Physician’s Residence) Home DHCS Designated Long Term Care Facilities with Long Term Beds Hospital In-Patient Hospital Out-Patient and Emergency Physician on Duty at Designated 24-Hour On-Site Emergency Department (seeAppendix “A’) Hospital Pain ClinicThese sites of insured service delivery are defined and described in the subsequentDefinitions of Terms/Conditions Section in this Preamble.2.4.2TelemedicineThis section of the Schedule describes the terms and conditions for billing Telemedicineconsultations and reassessments, and lists the fees and approved Telemedicine sites.2.5Critical CareThis section of the Schedule lists the fees for CPR and the per diem fee payable to the physicianin-charge for ICU/CCU/NICU Care, and for care in the Provincial Perinatal Care Unit.2.6Diagnostic and Therapeutic ServicesFees for miscellaneous diagnostic, therapeutic and surgical services are listed in this section.2.7In-Hospital Diagnostic and Therapeutic ServicesFees for specific diagnostic and therapeutic services performed in hospital are listed in thissection.A-3
October 1, 2019GENERAL PREAMBLE2.8RadiologyThis section of the Schedule lists fees and describes conditions for billing of Diagnostic ImagingServices except Nuclear Medicine Services.2.9Nuclear MedicineThis section of the Schedule lists fees and describes conditions for the billing of Nuclear MedicineServices.2.10ObstetricsThis section of the Schedule is designed for the billing of services related to pregnancy anddelivery. Other related services may be found in the Surgical Procedures Section.2.11Anaesthesia for Surgical-Dental ProceduresThis section of the Schedule lists fees payable for anaesthesia services for surgical-dentalprocedures.2.12Surgical ProceduresThe surgical procedures are listed by anatomical system. Under each system the procedurescarried out within the system have been grouped under such sub-headings as Incision, Excision,Suture, Repair, etc. Each procedure listed may be located through determination of theanatomical system to which it applies, and the type of procedure performed. This method oflisting has no relationship to the specialty which may be engaged in surgery upon this particularsystem.Fees for Surgical Assistants, Family Physicians, Specialists and Anaesthesiologists may belisted for each procedure. Where no fee is listed for Assistants or Anaesthesiologists, the servicemust be billed Independent Consideration (IC).2.13TablesTables are given for convenience when billing: I- Anaesthesia Basic Fee Code Rates II- Anaesthetic Time Units – Surgical Procedures III - Epidural Anaesthesia for Pain Control IV - SHV – Subsequent Hospital Visits – Type 2 V- SHV – Subsequent Hospital Visits – Types 3 and 4 VI - Units Table for Surgical Assistants – Billing According to Standard Method VII - Units Table for FP Surgical Assistants – Billing According to Dedicated Time MethodA-4
October 1, 2019GENERAL PREAMBLE3.3.1INSURED/NON-INSURED SERVICESInsured ServicesAn insured service is defined as one that is:(a)listed in Section 3 of the Medical Care Insurance Insured Services Regulations;(b)medically necessary. In a medical audit context, the clinical need of the provision andclaim of an insured service may be evaluated by the Medical Consultants’ Committeeof MCP;Queries as to the insurability of a specific service should be directed to the Officeof the Assistant Director of Medical Services. Regulations with respect to insurabilityof scar revision are listed in Appendix F.3.2Non-Insured ServicesThe following situations/conditions qualify as non-insured services:(a)specific services as listed in Section 4 of the Medical Care Insurance Insured ServicesRegulations or Appendix E of this Preamble,Queries as to the insurability of a specific service should be directed to the Office of theAssistant Director of Medical Services,(b)services not included in the Preamble Section that describes Common Elements of anInsured Service,(c)any medical services provided at the request of a third party, or which are covered byother agencies,(d)medical services provided to patients not insured by MCP or any other provincialHealth Care Plan,(e)services provided as a result of physician solicitation,Services which are reviewed by the Medical Consultant’s Committee (based on claimdetail, patterns of practice, physician records and patient evidence) and found to havebeen rendered as a result of direct solicitation by a physician, and found to be medicallyinappropriate are not insured by MCP. However, it is recognized that a small percentageof patients who require periodic medical assessment may be incapacitated or otherwiseunable to visit their doctor’s office. In these instances, where medical necessity can beclearly demonstrated, it is not deemed to represent solicitation.A physician, who notifies patients who are part of a target population designated by theDHCS for immunization that it is time to receive the injection, is not deemed to be“soliciting visits”.A recall program of women for speculum exams will not be viewed by MCPas constituting solicitation.A-5
October 1, 2019GENERAL PREAMBLE(f)services provided as a result of medical research and experimentation.Medical and professional services which are research-related or experimental are notinsured and are not the financial responsibility of MCP. Only those services related toroutine, accepted care of a patient’s problem and that are not in support of the researchrelated or experimental services are considered to be insured services.3.3Common Elements of Insured ServicesElements that are common to all insured services, and therefore not billable as an additional itemto either MCP or the patient, are:(a)being available to provide follow-up insured services to the patient and makingarrangements for coverage when not available,(b)making any arrangements for appointment(s) for the insured service,(c)making arrangements for any related assessments, procedures or therapy and/orinterpreting results,(d)obtaining and reviewing information (including history taking) from any appropriatesource(s) so as to arrive at any decision(s) made in order to perform the elements of theservice, unless stated otherwise,(e)obtaining consents or delivering written consents,(f)keeping and maintaining appropriate
Anaesthesia for Surgical-Dental Procedures Surgical Procedures Tables A-5 – A-6 Insured/Non-Insured Services, with divisions as follows: . J-2 Remodelling and Recontouring Oral Tissues J-2 Test, Histological J-2 – J-3 Surgical Excisions . L-10 Plastic Surgery Procedures L-11 Operations on the Breast M-1 – M-40 Operations on the .
payment schedule. This form can help you to prepare a payment schedule in response to a payment claim. You can use it, adapt it for your purposes, or decide not to use it at all. BEFORE YOU START Check to ensure that you provide the payment schedule on time The payment schedule must be served
4 payment options available to sars clients 5 4.1 payment option 1 - using efiling to make your payment 5 4.2 payment option 2 - payment at a sars branch 7 4.3 payment option 3 - using the internet to make electronic payment 9 4.4 payment option 4 - bank payments (at one of the relevant banking institutions) 10 4.5 foreign payments 11
date will need be stated on the payment claim itself. A payer has two options when it receives a Payment Claim: (1) make payment in full by the due date; or (2) use a Payment Schedule to dispute the amount claimed and pay a lesser amount (possibly 0). The Payment Schedule must be served a
6) payment instrument means any personalised device and/or a set of procedures agreed between the payment service user and the payment service provider and used by the payment service user in order to issue a payment order; 7) payment service user means a natural or legal person that uses or was using a payment service in the capacity of a payer
The main features in e-payment protocol are less charges of payment amount and high occurrence of transactions on the e-commerce system. 2.1Secure E-payment Protocol An e-payment process is a sequence of actions that involves a business task. There are mainly two kinds of payment transactions: i) Atomic payment transaction-single payment
Climate Change Impacts and Adaptation in Newfoundland & Labrador Executive Summary Climate change and variation impacts every sector, environment, and resident of Newfoundland and Labrador. This review is an attempt to list and summarize the available literature considering impacts and potential adaptations within and relevant to Newfoundland
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Acknowledgements Newfoundland and Labrador History - A Curriculum Guide vii Mr. Rene Wicks Newfoundland and Labrador Teachers' Association The Department of Education also gratefully acknowledges the contribution of Grade 8 teachers who
