SSC Fees FAQs

A. This fee premium is intended to support clinical coordination leading to effective discharge and community-based management of complex patients. It is to be billed for provision of a care plan for patients who require community support upon discharge, and who are otherwise at risk of readmission.

A. The Discharge Care Plan is not a discharge summary. The Discharge Care Plan is a written plan provided to the patient and the primary care provider to support immediate health care needs. It identifies the care providers and includes the necessary clinical information, including referral triggers and expected physiological changes, to support community based management of complicated patients. Please see the Discharge Care Paln template.

A. This fee is for communication with community care providers to improve the transition back to the community of complex patients who were admitted unexpectedly to hospital. It is intended to support collaboration with other providers, improve discharge information provided to patients, improve patient outcomes and reduce readmissions, and supports activities beyond those associated with a routine discharge.

A. SSC has a discharge planning template available for you to use. Discharge Care Plan template.

A. No, as long as the Care Plan is developed in consultation with the community providers and includes all of the mandatory data fields noted in the SSC Discharge Planning Template. The mandatory data elements include: Patient, Provider, and Primary Caregiver information, record of appropriate clinical information, interventions, co-morbidities and safety risks, re-referral triggers and description of arranged follow-up care, and expectation of symptom progression / remission and patient progress.

A. There is currently no billing rule that restricts Specialists that provide services to adult or neonatal ICU patients from billing the complex discharge care plan fee as long as all the requirements of the fee are met.

A. No. This fee is intended to support collaboration with other providers, improve discharge information provided to patients, improve patient outcomes and reduce readmissions, and supports activities beyond those associated with a routine discharge. As such, the patient’s primary care provider must be notified within 24 hours of admission. In addition, the patient’s care plan must be shared with the patient and their primary care provider within 24 hours of discharge.

A. Yes, provided consultation with the patient’s primary care provider occurs and they are involved in the development of the Care Plan.

A. If you are identified as the in-hospital MRP and provide clinical oversight of the care plan, including the oversight of patient discharge you may bill this fee.

A. Yes

A. The intent of the fee is to allow appropriate and comprehensive transition back into the community for the complex hospitalized patient. It is not intended to be used for the low acuity or low intensity patient, nor after routine post-operative care.

A. The Date-Of-Service is the day the patient was discharged.

A. SSC has discussed at length the conditions that make a patient complex, from specific clinical conditions to recognition of the psychosocial factors (i.e., poor socioeconomic status, dependency on a caregiver for daily living tasks, etc.). In order to bill for G10004 or G78717 Specialist Discharge Care Plan for Complex Patient Fees), Specialists must indicate that the patient meets the criteria for complexity as stated in the fee eligibility. That being said, keep in mind that SSC fees are not intended to be billed for the Specialist’s regular duties of care, but rather extraordinary efforts required for complex patients within a Specialists practice.

A. A Group Medical Visit provides medical care in a group setting. In addition to time spent in a larger group setting, a requirement of a GMV is a 1:1 interaction between each patient and the attending physician. These fees are not for efforts to persuade patients to alter diet or other lifestyle behavioural patterns, other than in the context of the individual medical condition.

A. While portions of the group medical visit may be delegated to a non-physician staff member, the Specialist must be present for a majority of the group medical visit and assumes clinical responsibility for the patients in attendance. Specialists cannot concurrently bill for other services during the time of the group medical visit.

A. Group Medical Visits are an effective way of leveraging existing resources; simultaneously improving quality of care and health outcomes, increasing patient access to care and reducing costs. Group Medical Visits can offer patients an additional health care choice, provide them support from other patients and improve the patient-physician interaction. Physicians can also benefit by reducing the need to repeat the same information many times and free up time for other patients. Appropriate patient privacy is always maintained and typically these benefits result in improved satisfaction for both patients and physicians.

A. No, group medical visits can only be billed for members of the group receiving medically required treatment. Parents, guardians and caregivers who are not receiving medically required treatment should not be billed for.

A. No. Group Medical Visits are not seminars or education sessions. They are medical office visits.

Providers conduct the same exam and lab review and answer the same questions that are addressed during a one-on-one office visit. Many people compare the Group Medical Visit to a seminar because of the wealth of information they receive, but Group Medical Visits are less than 50% education. The education is received is often indirect because of the shared environment.

A. The intent of this fee is to support Specialists to coordinate care of complex patients with multiple care providers including physicians and allied care providers. The fee is not intended to be billed for the Specialist’s regular duties of care, but rather extraordinary efforts required for complex patients within a Specialist’s practice. You can bill this fee if you conference with at least two other providers about a patient whose care is too complex for you to manage on your own.

A. The fee is not intended to be billed for the Specialist’s regular duties of care, but rather extraordinary efforts required for complex patients within a Specialist’s practice.

A. In order to bill this fee, the conference must be at least 15 minutes long per patient discussed. If the conference takes fewer than 15 minutes, then the fee criteria are not met.

A. Yes, provided all of the requirements in the fee notes are met. Each Specialist involved in the case conference must document their contribution to the discussion and its effect on the patient’s overall care in the medical record/chart along with the start and end times of the conference, and the names and job titles of the other participants at the meeting. There is no maximum number of Specialists who can attend and bill for G10004 provided that they are not concurrently being paid for these services when working under salary, service contract or sessional arrangement.

A. SSC has discussed at length the conditions that make a patient complex, from specific clinical conditions to recognition of the psychosocial factors (i.e., poor socioeconomic status, dependency on a caregiver for daily living tasks, etc.). In order to bill for G10004 or G78717 Specialist Discharge Care Plan for Complex Patient Fees), Specialists must indicate that the patient meets one of the three criteria for complexity as stated in the fee notes. That being said, keep in mind that SSC fees are not intended to be billed for the Specialist’s regular duties of care, but rather extraordinary efforts required for complex patients within a Specialists practice.

A. As with all fees, be sure to provide documentation that meets all of criteria set in the fee notes to meet billing and auditing requirements. Specifically for G10004, each Specialist involved in the case conference must document their contribution to the discussion and its effect on the patient’s overall care in the medical record/chart along with the start and end times of the conference, and the names and job titles of the other participants at the meeting.

A. The intent of these fees is for the Specialist to provide advice when the purpose of communication is to replace the need for the Specialist to see their own patient in person. The Specialist is responsible for ensuring that appropriate communication is used to meet the medical needs of the patient. This may help patients save time and other costs associated with travelling to see a Specialist and make it more likely that patients make their appointments, particularly in rural and remote communities. This could contribute to an overall increase in patients receiving care and better health outcomes.

A. When a Specialist needs to provide follow-up care via telephone or video conferencing to their own patient without the need for a face-to-face visit, a Scheduled Patient Follow-Up (G10003) can be billed per 15 minutes or portion thereof. A Specialist Email Patient Follow-Up (G100006) can be billed to provide follow-up care via to their own patient without the need for a face-to-face visit. Patient follow-up must occur with 18 months of the latest face-to-face visit.

A. No.

A. No. Patients must have a pre-existing relationship with you.

A. There is currently no limit to the number of times or time restrictions that the Patient Follow-up fee (G10003) can be billed. The Specialist Email Patient Follow-up fee (G10006) has a limit of 3 per patient, per day and 12 per patient, per physician each calendar year.

A. The same diagnostic code you would use for a patient whose has been referred to you.

A. As with all fees, be sure to provide documentation that meets all of criteria set in the fee notes. For G10003, be sure to document start and end times and time fields, clinical advice provided in the patient’s chart and/or an adequate medical record.

A. As with all fees, be sure to provide documentation that meets all of criteria set in the fee notes. For G10006, be sure to document clinical advice provided in the patient’s chart and/or an adequate medical record.

A. No. You may only bill this fee for email communication.

A. The intent of the fees is for Specialists to provide advice to another physician or allied care provider that may replace the need for the consulting Specialist seeing the patient in person. In doing so, patients are seen by the most appropriate physician and receive better access to Specialists; unnecessary face to face encounters and/or tests and interventions may be avoided. The consulting Specialist is responsible for ensuring that such communication meets the medical needs of the patient.

Specialist Advice fees are not intended for administrative tasks (‘What activities are not eligible to be billed for?’ in General FAQ) nor for activities that are within scope of the Specialist’s regular duties of care and should not be billed for these activities. Please note that a clinical discussion, which includes pertinent family/patient history, history of presenting complaint, and discussion of the patient’s condition and management after reviewing diagnostic and other relevant data, is a requirement of this fee.

A. The Specialist Advice fees are not billable if the patient was previously seen for the same condition in previous 180 days (10001) and 30 days (10002 and 10005) as the primary purpose of these fees is to provide advice on patients that you have not seen. Laboratory tests and x-rays do not count as a prior service in the context of these fees.

A. No. If the fees are billed more than once within the restricted time period for the same patient, it must be for a different condition rather than different ICD-9 code. While it’s possible that a general diagnostic code may change to a more specific diagnostic code over time, the underlying condition remains the same and therefore it is only appropriate to bill the fee once within the restricted time period. As with all fees, be sure to document as per the fee notes and bill carefully and appropriately.

A. Yes, but keep in mind that the SSC fees are not intended for duties that fall within a Specialist’s regular duty of care. Be sure to document the evidence of your discussion.

A. No, SSC fees cannot be billed if the sole purpose of the communication is to arrange for transfer of care that occurs within 24 hours. SSC fees are not intended for duties that fall within a Specialist’s regular duty of care.

A. No. The intent of these fees is to provide your Specialist expertise and advice to family physicians, other Specialist colleagues (or in the case of G10002 and G10005, including allied care providers). These fees are not payable for administrative tasks.

A. The Specialist Urgent Advice (G10001) is a flat fee to provide real-time advice to another physician within two hours of the request through two-way communication.

The Specialist Advice for Patient Management (G10002) fee is time-based and payable per 15 minutes or portion thereof, for real-time communication within seven days of the request with other physicians and/or allied care providers regarding the clinical management of the patient.

The Specialist Email Advice for Patient Management (G10005) is a flat fee for email advice within seven days of the request to other physicians and/or allied care providers regarding the clinical management of the patient.

A. You may only bill G10002 and G10005 for advice provided to allied care providers. The fee you bill will depend on the communication method used. If you provide advice within seven days of the initiating request by telephone, face–to-face or video conferencing, you may bill “Specialist Advice for Patient Management (10002)”. If you provide advice within seven days of the initiating request by email, you may bill “Specialist Email Advice for Patient Management (10005)”. A general practitioner number (99987) should be used for documenting advice provided by allied care providers not registered with MSP.

A. No. Only the Specialist providing advice can bill.

A. Yes.

A. Yes. You can bill this fee regardless of how the initiating request was made (i.e. phone, email, video-conference).

A. No. Regardless of how promptly the advice is provided, 10001 can only be billed for advice to another physician or health care practitioner. Per the MSP Fee Guide, health care practitioners are any of the following persons entitled to practice under an enactment: a) a chiropractor, b) a dentist, c) an optometrist, d) a podiatrist, e) a midwife, f) a nurse practitioner, g) a physical therapist, h) a massage therapist, i) a naturopathic physician or j) an acupuncturist.

A. If the advice is provided to an allied care provider, G10002 must be used. If the advice is to another physician or health care provider, G10001 would be use. In either care, the advice provided should not be part of a Specialist’s regular duty of care. Specialist Advice fees are not intended to be billed for administrative tasks (Link to corresponding question ‘What activities are not eligible to be billed for?’ in General FAQ) nor for activities that are within scope of the Specialist’s regular duties of care. Please note that a clinical discussion, which includes pertinent family/patient history, history of presenting complaint, and discussion of the patient’s condition and management after reviewing diagnostic and other relevant data, is required for this fee.

A. The SSC fees are not payable for situations in which the sole purpose of the communication is to book an appointment, expedite consultations or procedures within 24 hours or arrange a transfer of care within 24 hours. Keep in mind that the SSC fees are not intended for duties that fall within a Specialist’s regular duty of care.

A. A GP who has specialty training and who provides services in that specialty area through a health authority supported or approved program may claim Specialist advice under with the FPSC G14021, G14022 and G14023 fees respectively. While the fees are very similar, they are not identical. Please review the FPSC Billing Guide before billing these fees.

A. As with all fees, be sure to provide documentation that meets all of criteria set in the fee notes. Specialists are required to make an adequate medical record/chart entry that includes time of initiating request, time of response, start and end time (for 10002 and 10005 only), advice given and to whom. Physicians are required to bill include practitioner number of the individual seeking advice for both physicians and/or allied care providers. A generic practitioner number (99987) should be used for documenting advice provided by allied care providers not registered with MSP.

A. No. You may only bill this fee for email communication.

A. While we recognize many providers still communicate by fax, SSC fees incent physicians to embrace newer technology (i.e. email and video conferencing) in a safe and appropriate manner.

A. SSC Fees are managed by the Tariff Committee of Doctors of BC, with the ongoing involvement of the Specialist Service Committee. A working group comprised of Ministry of Health and Doctors of BC physician representatives provide recommendations to the Tariff Committee on the fees.

A. For the time period April 1, 2020 to March 31, 2022, all SSC fees are categorized within the MSP Fee Guide as provisional; that is, there will be monitored for utilization in preparation for possible permanent inclusion into the Fee Guide. During this time period, SSC will be responsible for utilization growth of the fees beyond 2.4% annually. If utilization growth during this time period is very high, the SSC may recommend to the Tariff Committee that rule changes be made to manage growth.

A. SSC fees are not payable for situations where the sole purpose of the communication is to:

a) book an appointment

b) arrange for transfer of care that occurs within 24 hours

c) arrange for an expedited consultation or procedure within 24 hours

d) arrange for laboratory or diagnostic investigations

e) inform the referring physician of results of diagnostic investigations

f) arrange a hospital bed for the patient

g) renew prescriptions with a pharmacist (during the COVID-19 pandemic, a new fee(T10007) has been introduced to allow for prescription renewal). For more information on all COVID-19 fees for specialists, click here to learn more

As with all MSP fees, be sure to provide documentation that meets all of criteria set in the fee notes. Visit the Doctors of BC website for common billing and audit errors.

A. Electronic communication as part of patient care must ensure that security and patient confidentiality are maintained and guarded in the same way that paper records are protected.

• The CMPA and the CPSBC recommendations regarding the use of electronic communications indicate three major areas of potential liability:

  • Confidentiality/privacy/security

  • Timeliness of Response

  • Clarity of Communication

• Document consent. Obtain express and informed consent before transmitting patient information. Refer to the CMPA Template for consent to use electronic communications: https://www.cmpa-acpm.ca/

• Document discussion & advice for all communications.

• The email record should be included in the patient record.

• Develop clear, written policies around use of email.

• Communication between providers should clearly identify the most responsible physician (MRP).

• Information should be encrypted as an attachment, or, at a minimum, password protected. Send password or cryptographic key separately.

• Use secure communication modalities (i.e. Health authority email addresses) if possible.

• Email addresses need to be double-checked.

A. During the COVID-19 pandemic, a temporary fee had been introduced (T10007) to allow for communication by instant message, text or short message service (SMS) modality. For more information on all COVID-19 fees for specialists, click here

A. No, SSC fees are not payable to physicians for services provided within time periods when working under salary, service contract or sessional arrangement. With the exception of the advanced care planning and discharge care planning fee for complex patients which are premiums, SSC fees cannot be billed concurrently with any other fee.

A. If you are unsure about how to bill the fees, you can receive trusted advice from Doctors of BC’s Lea Harth, Fee Guide Assistant lharth@doctorsofbc.ca or call 604-638-2827 or MSP/HIBC Provider Programs 604-456-6950 (Vancouver) or 886-456-6950 (rest of the province).

A. The intent of the fee is to support the initiation of proactive advance care planning, and is not suitable when a patient is already in hospital with a critical illness.

A. Online resources include:

An SSC Advance Care Plan Template form
Ministry of Health – Advance Care Planning
End of Life Module

A Practice Support Program (PSP) End of Life Module is also available for physicians who wish to learn more about advance care planning and end of life care. The PSP Module provides training for practitioners to improve care of patients and families living with, suffering and dying from life-limiting and chronic illnesses. Physicians learn how to identify patients who could benefit from a palliative approach to care; increase confidence and communication skills to enable Advance Care Planning (ACP) conversations; and improve collaboration with providers, patients, families and caregivers.

A. Advance care planning is the process whereby a capable adult forms his/her beliefs, values and wishes for health care in the event of future incapacity. Advance care planning discussions may take place with family, trusted friends, and/or health care providers.

A. This fee premium is intended to support discussions with adult patients about their beliefs, values and wishes for health care in the event of future incapacity. Evidence shows that introducing discussions about values, goals, and wishes for end of life is better for both patients and providers. These discussions are not easy, but normalizing them by introducing them early can have tremendous impact. The process of advance care planning improves the patient, family, and provider experience at the end of life in a number of ways, including:

• Decreasing the likelihood of overly aggressive treatment at the end of life.

• Increasing patient and family satisfaction with care received at the end of life.

• Easing the bereavement process for surviving loved ones.

A. The patient should control and keep his/her written advance care plan. A copy of the plan, including any changes, should be put in the patient’s medical file and shared with his/her primary health care provider, and if applicable any other Specialist involved in caring for the patient. The purpose is to ensure that all relevant care providers are aware of the patient’s future health care wishes.

A. Yes to both. The fee premium is only billable if all the requirements of the fee are met, which includes a discussion with the patient, and a written advance care plan that is shared with the patient and the patient’s primary care provider. The advance care plan should document the discussion, including the patient’s values, and any future health care treatment goals and wishes (e.g. full treatment/care or an alternative course of action).

A. If the patient already has a current written advance care plan, you should obtain a copy of the most current plan directly from the patient or from his/her primary health care provider. You will not be able to bill the fee premium if the patient already has an up-to-date advance care plan. However, if your discussion with the patient requires you to make changes to the advance care plan, then you are eligible to bill the fee premium. You will be required to share the revised care plan with the patient, his/her primary health care provider, and if applicable any other Specialist(s) involved in caring for the patient.

A. Yes. Patients may require more than one discussion regarding advance care planning and may have the discussion with several physicians including his/her primary care provider. The fee premium can be billable more than once for the same patient, provided all the requirements for billing the fee are met. If a Specialist develops an advance care plan with the patient, or makes any changes to the patient’s current plan, all relevant providers should be informed.