for uninsured services - Saskatchewan Medical Association

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SECTION A.4:GENERAL SERVICESsevere shock, coma). The specific elements are those of an assessment, includingimmediate crisis related examination, on going monitoring of the patient'scondition and the usual resuscitative procedures as required: defibrillation,Feecardioversion, cutdowns, intravenous lines, arterial and/or venous catheters,pressure infusion sets and pharmacological agents, urinary catheters, CVP lines,blood gases, nasogastric tubes, endotracheal intubation and tracheal toilet.Time is to be measured as the period of constant attendance excluding timerequired for any separately billable intervention (service). If a physician startsbilling codes 220A to 223A, the resuscitation should finish with this series of codes.Amount payable per physician per life threateningemergency situation for the first two physiciansfor which a claim is submitted and paid220A - first 15 minutes $200.00221A - second 15 minutes $100.00222A - after first 30 minutes (per 15 minutes or $90.80major portion thereof)223A Amount payable per physician per life threatening $90.80emergency for third and subsequent physiciansfor which a claim is submitted and paid-- per 15 minutes or major portion thereofOther Resuscitation - is different from Life Threatening Emergency Situationonly in that it applies to providing resuscitation in emergency situations otherthan listed above and only includes the following resuscitative procedures:cutdowns, intravenous lines, arterial and/or venous catheters pressure infusionsets and pharmacological agents, urinary catheters, CVP lines, blood gases,nasogastric tubes, with or without lavage, and tracheal toilet. Time is to bemeasured as the period of constant attendance excluding time required forany separately billable intervention (service). If a physician starts billing codes224A to 226A, the resuscitation should finish with this series of codes.Amount payable per physician per OtherResuscitation for the first two physiciansfor which a claim is submitted and paid224A - first 15 minutes $100.00225A - after first 15 minutes (per 15 minutes or major $90.80major portion thereof )226A Amount payable per physician per other $90.80resuscitation for the third and subsequentphysicians for which a claim is submitted andpaid -- per 15 minutes or major portion thereofConsultation or assessment rendered before or after provision of resuscitativecare or neonatal intensive care may be claimed on a fee-for-service basis butnot when claiming Intensive (Critical, Ventilatory or Comprehensive) Care perdiem fees. When claiming Critical, Ventilatory, or Comprehensive Care per diemfees, no other Intensive Care codes may be claimed by the same physician(s).SPECIAL CALL SERVICES AND SURCHARGESA. Preamblel. Payment for a special call will be made only if the call is initiated by the patient,or someone other than the physician, on the patient's behalf.ll. Special call payments are claimable for where a physician attends a patient on a prioritybasis, and the visit causes a degree of disruption of work or of out of hours activity, and travel(except in the case of additional patients seen). When more than one patient is attended,SMA FEE GUIDE- A31 -April 1, 2012
SECTION A.4:GENERAL SERVICESthe surcharge for "additional patient" would apply. Please note - you cannot bill foradditional patients seen from 8 a.m. to 5 p.m. weekdays. Payment for a special call doesnot apply where a physician is specially called to another location in the hospital when heis already in the building.FeeSurcharges may apply to a service ata) the patient's home;b) hospital out-patient or emergency department;c) Special Care Home;d) physician's office when the physician is called back from some other place;e) other locations.lll. Payment will be made for the examination and/or procedure provided plus the appropriatesurcharge.lV. Where a surcharge is billed in connection with a major surgical procedure, fracture,dislocation or delivery, one surcharge is billable per case per physician.V. Special call services are categorized by time of day.Vl. "Weekend" refers to the period from 5:00 p.m. on Friday to midnight on Sunday."Statutory Holiday" refers to the entire 24 hour period of the specific day.Vll. The statutory holidays in each year are: January 1, Good Friday, Family Day(3rd Monday in February), Victoria Day, July 1, first Monday in August, Labour Day,Thanksgiving Day, Remembrance Day, Christmas and Boxing Day. If any of thesedays fall on Saturday or Sunday, they will be observed as stated in thePhysician's Newsletter.B. Special Callsl. Weekdays815A Surcharge -- 8 a.m. to 5 p.m. $77.40 *817A Surcharge -- first patient seen -- 5 p.m. to $113.00 *midnight (Monday - Thursday)837A Surcharge -- each additional patient seen -- 5 p.m. $56.00 *to midnight (Monday - Thursday)819A Surcharge -- first patient seen -- Midnight to 8 a.m. $264.00 *839A Surcharge -- each additional patient seen $76.00 *-- Midnight to 8 a.m.ll. Weekends and Statutory Holidays (or designated days)816A Surcharge -- first patient seen -- 8 a.m. to 5 p.m. $102.00 *836A Surcharge -- each additional patient seen $51.00 *-- 8 a.m. to 5 p.m.818A Surcharge -- first patient seen -- 5 p.m. to $138.00 *Midnight (Friday to Sunday)838A Surcharge -- each additional patient seen -- 5 p.m. $68.80 *to Midnight (Friday to Sunday)819A Surcharge -- first patient seen -- Midnight to 8 a.m. $264.00 *839A Surcharge -- each additional patient seen - Midnight to 8 a.m. $76.00 *lll. Emergency -- day or night -- any day721A -- Surcharge, in addition to payment for an $178.00 *appropriate assessment and/or procedureThis surcharge is payable where a physician travels to respondimmediately to a stat call involving a life-threatening situation,provides immediate care and arranges for the patient'semergency admission as a hospital in-patient.SMA FEE GUIDE- A32 -April 1, 2012
Page 1 and 2: SMA Fee Guide (for uninsured servic
Page 3 and 4: INTRODUCTION / PREAMBLEAn understan
Page 5 and 6: INTRODUCTION / PREAMBLE8. Classific
Page 7 and 8: INTRODUCTION / PREAMBLERequests fro
Page 9 and 10: INTRODUCTION / PREAMBLEa) Keep Pati
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Page 13 and 14: SECTION A1:UNINSURED SERVICESIIIRES
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Page 51 and 52: SECTION B:GENERAL PRACTICEGeneral P
Page 53 and 54: SECTION B:GENERAL PRACTICE35B- per
Page 55 and 56: SECTION B:GENERAL PRACTICE15 minute
Page 57 and 58: SECTION C:PAEDIATRICSVisitsFee3C Co
Page 59 and 60: SECTION C:PAEDIATRICSFeeCardiorespi
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SECTION I:CARDIOLOGYFee Anae105I Fu
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SECTION K:NEUROSURGERYFeeHospital C
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SECTION K:NEUROSURGERY540K -- each
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SECTION MORTHOPAEDIC SURGERYClassif
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SECTION N:PLASTIC SURGERY2. Correct
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SECTION N:PLASTIC SURGERYFeeAnae367
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SECTION O:PHYSICAL MEDICINEVisitsFe
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SECTION P:OBSTETRICS/GYNAECOLOGYFee
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SECTION P:OBSTETRICS/GYNAECOLOGYplu
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SECTION Q:NEUROLOGYFeeHospital Care
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SECTION S:OPHTHALMOLOGYVisitsFee5S
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SECTION T:OTOLARYNGOLOGYVisitsFee5T
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SECTION V:LABORATORY MEDICINELabora
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SECTION W:DIAGNOSTIC ULTRASOUNDTech
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SECTION X:DIAGNOSTIC RADIOLOGYTechn
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SECTION X:DIAGNOSTIC RADIOLOGYSpeci
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SECTION X:DIAGNOSTIC RADIOLOGYFeeAn
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SECTION Y:THERAPEUTIC RADIOLOGYThis
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SECTION Z:NUCLEAR MEDICINETechnical
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SECTION Z:NUCLEAR MEDICINETechnical
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Hand Surgery AppendixFeeAnaeTenolys
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