When billing Alberta Health, you must choose the appropriate health service code that matches the service you provided – as well as any relevant fee modifiers that may apply.
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Below is a list of fee modifiers and their definitions:
AGE – AGE – Identifies specific services which are payable at different rates depending upon the age of the patient.
ANEU – ANESTHETIC LISTED RATE UNITS – This modifier is system derived from the information in the calls field for multiple services of same Health Service Code when the anesthetic role modifier (ANE) is used.
ANU – ANESTHETIC TIME UNITS – This modifier is system derived from the information entered in the calls field when the Anesthetic Time role modifier (ANEST) is used. EACH UNIT REPRESENTS 5 MINUTES. ADDITIONAL 5 MINUTE UNITS MAY NOT BE CLAIMED UNLESS A FULL 5 MINUTES HAS ELAPSED.
ARFC – AUTOMATIC RAPID FILM CHANGER – Increases rate of a procedure with automatic rapid film changer.
BMI – BMI – This modifier is used to support the additional payment of 25% for selected procedures, obstetrical services, anesthesia, second qualified surgeon and surgical assistant services for adult patients who meet requirements indicated in the Governing Rules and patients under 18 years of age who are above the 97th percentile for BMI on an approved pediatric growth curve.
CAGE – CORRECTED AGE – This modifier is used to support the additional payment of 25% for specific general surgery procedures and specific anesthetic services for patients with a “corrected” age of up to 3 months.
CALL – CALLS UNITS – This modifier is system derived from the information entered in the calls field for multiple services. The calls field indicates the number of services claimed. The modifier value code indicates what each unit/call represents (time, size, number).
CARE – COMPLEX PATIENT CARE – Used to indicate complex patient care.
CMPD – COMPOUND – Used to indicate a compound fracture as described in GR 6.11.1.
CMPX – COMPLEX TIME – This modifier type is used to indicate a complex patient visit payable in time units by general practitioners only.
INCS – INCISIONS – This modifier is to be used for gynecological health service codes only to indicate multiple procedures were performed through a different incision.
LEVL – LEVEL – Calculates the rate payable for consecutive hospital days. The modifier value code is a combination using “level” for the date range and “skill” for the rate variations. If the service provider does not have one of the skills listed in this level modifier list, the system defaults to the rates indicated in HD1 and HD2. The Calls field and the Hospital Admission Date/Originating Encounter Date field must be entered when hospital days are claimed.
LMTS – LIMITS – This modifier is used to override restrictions for a service/procedure.
LVP – LESSER VALUE PROCEDURE – Indicates that the procedure should be processed at a reduced rate. IF BASE RATE AMOUNTS ARE EQUAL ON THE HSCS CLAIMED, LVP50 OR LVP75 ARE NOT TO BE USED.
NBPG – NUMBER OF PATIENTS IN GROUP – Used to indicate the number of people in a psychiatric, or teaching group. A two digit numeric character must be added to the modifiers’ alpha character, Example: NBPG08. This two digit numeric character represents the number of people participating in the psychiatric or teaching group. Depending on the skill indicated the rate is divided by the number of people to determine the rate per person per 15 minutes. This modifier will be used in conjunction with the appropriate units modifier that is based on time, and is derived from the calls field used if the visit exceeds 15 minutes.
NBTR – NUMBER OF TRAYS – Used to indicate that multiple trays were used as described in Governing Rules 14.1, 14.2, 14.3, 14.3.1, 14.3.2 and 14.3.3. This modifier code must have a two digit numeric character attached indicating the number of trays used (Example: NBTR02).
NOFL – WITHOUT FLUOROSCOPY – Used to indicate an xray which usually requires fluoroscopy was performed without the fluoroscopy component.
RECO – RECONSTRUCTION – Used to indicate the type of tissue repair or if a procedure was performed through an open incision.
REDO – REDO PROCEDURE – Cardiac, Vascular, and Thoracic surgery as described in GR 6.15, re-operation for specific general surgery or ophthalmology procedures, or orthopedic procedures as listed in GR 6.17.1.
REPT – REPEAT – Indicates the same service was performed previously and therefore this service is payable at a modified rate.
ROLE – ROLE – This modifier indicates the capacity in which the service provider is functioning. This is an explicit modifier, however if no role modifier is identified, the system will assume the service provider functioned as the surgeon. The surgical assistant (SA) modifier may not be claimed with the following role modifiers by the same physician for the same service for the same patient during the same encounter. ASIC, MSURG2, MSRGN, MSRGP, SAQS, SSOS, SSCVT, SSST
SAQU – SURGICAL ASSISTANT QUALIFIED SECOND SURGEON UNITS – This modifier is system derived from the information entered in the calls field when the Surgical Assistant Qualified Second Surgeon role modifier (SAQS) is used. EACH UNIT REPRESENTS 15 MINUTES.
SAU – SURGICAL ASSIST UNITS – This modifier is system derived from the information entered in the calls field when the Surgical Assist role modifier (SA) is used. THE FIRST UNIT REPRESENTS 1 HOUR, EACH SUBSEQUENT UNIT REPRESENTS 15 MINUTES.
SESU – SESSIONAL UNITS – This modifier is used to indicate the duration of a psychiatric service to be paid on a sessional basis. The modifier is system derived from the information entered in the calls field when skill GNMH or SPMH are used. EACH UNIT REPRESENTS ONE 15 MINUTE PERIOD. The skill (GNMH or SPMH) must be used with this modifier to determine amount payable.
SKLL – SKILL – The SKILL modifier designates the discipline and specialty/accreditation under which the service provider provided the service. This is an implicit modifier, however if using another skill, it is an explicit modifier and it is derived from the skill field on the claim instead of the default skill.
SOSU – SECOND ORAL SURGERY SURGEON UNITS – This modifier is system derived from the information entered in the calls field when the Second Oral Surgery Surgeon role modifier (SOSS) is used. THE FIRST UNIT (SOSS) REPRESENTS 45 MINUTES; EACH SUBSEQUENT UNIT (SOSU) REPRESENTS 15 MINUTES OR THE MAJOR PORTION THEREOF.
SSOU – SECOND SURGEON ORTHOPEDIC SURGEON UNITS – This modifier is system derived from the information entered in the calls field when the Second Surgeon Orthopedic Surgeon role modifier (SSOS) is used. THE FIRST UNIT (SSOS) REPRESENTS 45 MINUTES; EACH SUBSEQUENT UNIT (SSOU) REPRESENTS 15 MINUTES OR THE MAJOR PORTION THEREOF.
SSPU – SECOND SURGEON PODIATRIC SURGEON UNITS – This modifier is system derived from the information entered in the calls field when the Second Surgeon Podiatric Surgeon role modifier (SSPS) is used. THE FIRST UNIT (SSPS) REPRESENTS 45 MINUTES; EACH SUBSEQUENT UNIT (SSPU) REPRESENTS 15 MINUTES OR THE MAJOR PORTION THEREOF.
SUBD – SUBD SUBDIVISION – This modifier type is used with visit health service codes to indicate during which time period the service recipient/service provider encounter took place. These modifiers are applicable during the evening on weekdays, during the day and evening on weekends and statutory holidays, and during the night on any day. A fee is added to the base rate as indicated by the modifier. For home visits and hospice visits, the SUBD modifier should be claimed based on the time at which the encounter commences and the physician responds on an unscheduled basis within a 24 hour period from the time of the call.
SURC – SERVICES UNSCHEDULED – This modifier type is used for services listed in the GRs to indicate during which time period a service provider provided unscheduled in-patient or out-patient services for a hospital service recipient. A fee is added to the base rate as indicated by the modifier. For visits, refer to the subdivision modifier.
SURT – AFTER HOURS TIME PREMIUM – This modifier type is used to indicate after hours time units for services provided to patients in active treatment hospitals, AACCs, UCCs, nursing homes and auxiliary hospitals. This modifier is payable in 15 minute blocks to a maximum of 4 per hour, per physician. It is to be billed beginning at the time of contact with the patient and may only be claimed for direct patient care time related to the provision of an insured service. The after-hours time premium units may not be claimed for stand by time, e.g. time spent waiting for results of diagnostic tests. In the event that one 15 minute period covers two time periods, the modifier claimed will be based on the time period where the majority of the 15 minute period was spent. In the event that the time spent with the patient covers more than one time period, additional SURT modifiers may be claimed, each according to the time spent with the patient in that particular time period.
TELE – TELEHEALTH – This modifier is used to indicate telehealth services.
TRAY – TRAY – A specified amount is added to the base amount for procedures listed in Governing Rule 14.1 and 14.2. If more than one tray is used refer to NBTR.
TSAR – TWO SURGEONS SAME ANATOMICAL REGION – Used to indicate that payment for the 2nd surgeon is to be made according to the Price List. Example: Health Service Code 14.49H (tumor of the cranial base). Base rate is payable for the neurosurgical component performed by the neurosurgeon. If the otolaryngological component is performed by a second surgeon, modifier ENT must be applied to Health Service Code 14.49H.
UGA – PROCEDURE UNDER GENERAL ANESTHETIC – Increases payment for services performed under general anesthetic in accordance with restrictions listed in the Governing Rule.
UNDP – UNDISPLACED – Used to indicate an undisplaced fracture as described in Governing Rule 6.11.2.
VANE – VARIABLE ANESTHETIC – Indicates a specific rate adjustment for role ANE and/or ANEST with specific HSCs.
XRAY – XRAY STUDIES – Used to indicate that an xray was performed with the use of video, stereo, or cine studies or that tomography was used in addition to mammography services.
2ANU – ANESTHETIC TIME PREMIUM UNITS – This modifier is system derived from the information entered in the calls field when the Anesthetic time unit premium role modifier (2ANES) is used. EACH UNIT REPRESENTS 5 MINUTES. ADDITIONAL 5 MINUTE UNITS MAY NOT BE CLAIMED UNLESS A FULL 5 MINUTES HAS ELASPED.
2MNU – SECOND NEUROSURGEON MICROSURGERY UNITS
2MPU – SECOND PLASTIC SURGEON MICROSURGERY UNITS
2MSU – SECOND MICROSURGERY UNITS – This modifier is system derived from the information entered in the calls field when the second Microsurgery role modifier (MSURG2) is used. EACH UNIT REPRESENTS 1 HOUR.
For a complete guide on how to submit claims for refurbishment in Alberta check out our Alberta Health Billing Guide.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
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