Remuneration terms for services rendered during Covid 19 pandemic.– GENERAL PRACTITIONERS

Updated 2020-06-26

Here is the relevant information regarding the new terms, adjustments to existing terms and billing details for services related to the current pandemic:

Letter of Agreement 269 (LE269) is effective as of February 28, 2020, except for services performed remotely (teleconsultations) which are effective as of March 16, 2020. Please note that the billing grace period has been temporarily extended to 120 days.

Six COVID-19 situations (more than one situation may affect remuneration) >

Choose 1 or 2 depending on the usual mode
Choice 1 – USUAL REMUNERATION MODE – FEE-FOR-SERVICE OR MIXED:
Eligibility requirements:
  • Physician performing services remotely, from any place/sector/location
  • No contract/designation required
Billing instructions:
Depending on communication method used :
  • #TT Telemedicine over the phone (Ex. : 15774#TT)
OR
  • #TT Telemedicine via videoconference (Ex. : 15774#TV)
Visits (office / GMF-U / CLSC)
  • First-time visit / Orphan patient package / Annually GMF package 8875 -> Billable. Examination required = Plan to a future appointment.
  • Periodics -> Not billable if an exam. is required. Choose follow-up or Clinical intervention (IC) if it is the case.
  • Follow-up visit/Walk-in visit/Clinical intervention
    (IC) -> Billable.
  • Severe loss of autonomy visit -> Not billable. Select another type of visit.
  • Can be billed as usual
  • No limitation
  • Not restricted to the number of registered patients
    (- 500 patients -> use 15841 or 15844)
  • Patient diseabled/immature -> Bill the services as if patient was seen in person
  • Less than 25 minutes -> Use code 15909 (Ex. : 15909:15) even if services rendered were less than 15 minutes
  • 25 minutes and over -> Bill a clinical intervention (IC) specifying exact beginning and end times
  • VSE (codes 15617, 15628, 8913 or 8942) -> Billable if equiv. to complex walk-in visit
  • VSC (codes 15616, 15627 or 8933) -> Billable if equiv. to minor walk-in visit
  • Ordinary exam. / Ord. consult. -> Billable if equiv. to minor walk-in visit
  • Main exam. / Major consult. -> Billable if equiv. to complex walk-in visit
  • Physician on-duty on follow-ups for patients previously seen at the ER -> Bill as if he/she was on site
Choice 2 – USUAL REMUNERATION MODE - HOURLY RATE OR FIXED FEE:
Eligibility requirements:
  • Physician performing services remotely, from any sector/facility
  • Usual remuneration contract
Billing instructions:
Depending on communication method used :
  • #TT Telemedicine over the phone (Ex. : 8877#TT)
OR
  • #TV Telemedicine via videoconference (Ex. : 8877#TV)
For services rendered up until June 19th -> Use hourly rate code -> XXX319 Services cliniques à distance (pandémie COVID-19)
For services rendered beginning June 20th :
  • Over the phone -> Use code TH XXX352 Services cliniques à distance par téléphone (pandémie COVID-19)
  • Via videoconference -> Use code TH XXX353 Services cliniques à distance par visioconférence (pandémie COVID-19)
Daily Choices
Choice 1

LE269 PACKAGE CLAIM

Eligibility requirements:
  • Physician on the “hot zone” ward list
  • OR
  • Cold or hot zone in a sociosanitary region identified as a hot zone (Montréal, Laval, Lanaudière et Montérégie)
  • LE 269 designated facility/unit
  • Billable during operation hours of the CDÉ/Unit
  • Emergency Room outside of a sociosanitary region identified as a hot zone (as of June 15th, 2020)
    • Category 1 ER – more than one physician can bill as per option 1
    • Category 2 and 3 ER – only one physician can bill as per option 1
Billing instructions:
  • Rate increase -> Applies to unfavourable hours time slots (codes 19680 and 19681)
    • % CHSGS / CHSLD -> Bill on a different line as of 0h, 8h and 20h (8pm)
    • % CABINET / CLSC -> Bill on a different line as of 0h, 8h and 18h (6pm)
  • Code 19680 ($186.15/hour) -> Fixed rate per hour completed.
    • Services rendered before May 21st -> Bill code:minutes :
    • Services rendered as of May 21st -> Bill code:minutes:beginning time-end time ( )
    Services between 16h(4pm) and 24h(midnight) designated facility 0XXX7
    • Sector = ER
    • Beginning time ligne 1 = 16:00 / Code = 19680:240:1600-2000
    • Beginning time ligne 2 = 20:00 / Code = 19680:240:2000-2400
  • Code 19683 ($35.30/hour) -> Unfavourable hours Supplement
    • Billable week nights from 18h(6pm) to 24h(midnight) / Week ends and Holidays 0h to 24h
    • Use one line-> code:minutes:beginning time-endtime ()
    Services rendered on SATURDAY BETWEEN 8h and 16h(4pm)) designated facility 0XXX7
    • Sector = ER
    • Beginning time ligne 1 = 08:00 / Code = 19680:480:0800-1600
    • Beginning time ligne 2 = 08:00 / Code = 19683:480:0800-1600
  • Code 19681 ($62.75/hour) -> Office fees/expenses package (Physician assuming office expenses for his usual clinic)
    • Services rendered before May 21st-> Bill code:minutes
    • Services rendered as of May 21st -> Bill code:minutes:hredébut-hrefin ()
    Services rendred between 16h(4pm) et 24h(midnight), ON A HOLIDAY, in a CHSLD facility when the physician would normally be working at his office :
    • Sector/Facility. = # of the designated CHSLD
    • Beginning time ligne 1 = 16:00 / Code = 19680:240:1600-2000
    • Beginning time ligne 1 = 16:00 / Code = 19680:240:1600-2000
    • Beginning time ligne 3 = 20:00 / Code = 19680:240:2000-2400
    • Beginning time ligne 4 = 20:00 / Code = 19681:240:2000-2400
    • Beginning time ligne 5 = 16:00 / Code = 19683:480:1600-2400
  • SERVICES RENDERED -> No other remuneration
Questions/Answers:
For the evaluation clinics (CDÉ), GMF and GMF-R, physicians having scheduled ward for a portion of the day could bill the rest of the day using the usual remuneration mode. When the ward exceeds the CDÉ opening hours, the usual mode must be billed.
No
A physician who is on the ward list of the “hot-zone” and who must cover all zones must choose between the fixed fee package and his/her usual mode.
He/she should bill using the usual remuneration mode.
Yes, but the time used to fill the report must be deducted from code 19680.

  • For any other question, go to the FMOQ’s Q/A tools
Choice 2

MAINTAINING THE FEE-FOR-SERVICE OR MIXED REMUNERATION MODE:

Eligibility requirements:
  • Fee-for-service or mixed remuneration usual mode
  • Not billable if choice 1 LE269 package (code 19680) is billed
  • Physician on the “hot zone” ward list
  • LE 269 designated facility/Unit
Billing instructions:
  • Services/package fees -> Bill the package fees/services as usual with context element #C19
  • To compensate for office fees (outpatient clinic., CLSC or GMF-U) -> The following supplements can be billed in addition to the visit:
Eligible examinationBilling codeRate ($)
Ordinary exam, or walk-in minor visit, all ages (billing code 5, 8882, 8883, 15765, 15766, 15767, 15768, 15769, 15770, 15771, or 15772) 153007,65
Complete exam for a patient less than 70 years old or walk-in complex visit for a patient less than 80 years old (billing code 56, 15773, 15774, 15775, or 15776)1530113,35
Complete exam for a patient 70 years old or over, or walk-in complex visit for a patient 80 years old or over (billing code 9116, 15777, 15778, 15779, or 15780)15302 21,45

MAINTAINING THE HOURLY RATE OR FIXED FEE MODE:

Eligibility requirements:
  • Usual hourly rate or fixed fee contract
  • Not billable if choice 1 LE269 package (code 19680) is billed
  • Physician is on the “hot zone” ward list
  • LE 269 designated facility/unit
Billing instructions:
  • Use hourly rate code XXX346 Services cliniques – COVID-19. (This code replaces hourly rate code XXX158 Services clinique de grippe as of May 1st 2020)
  • Claim forms must be signed by authorized professional (signataire)
  • Consultation register -> No
PREVENTIVE LEAVE OF ABSENCE
Eligibility requirements:
  • Pregnant physician who accepts to be reassigned
  • If she cannot be reassigned, she must remain available
How to submit a request:
  • Obtain a signed notice of preventive leave of absence by a physician
  • Submit the notice to the DSP or DRMG
  • Present the request to the joint committee (comité paritaire) to receive approval
Terms:
Reassigned physician on hourly rate mode:
  • (Medical tasks) -> Use hourly rate code XXX344 Tâches médicales – Retrait préventif
  • (Medico-admin. tasks) -> Use hourly rate code XXX345 Tâches médico-administratives – Retrait préventif
Reassigned physician on fee-for-service mode:
  • Bill the services with context element #DC19 or #C19 according to the situation
Non-reassigned physician:
  • Isolation measures
ISOLATION MEASURES / SICK LEAVE
Eligibility requirements:
  • As of March 1, 2020
  • Must not be working
  • Eligible when infected with COVID-19
  • Eligible when exposure can be demonstrated to joint committee (if not in a COVID clinic)
  • Eligible when in recommended isolation measures
How to submit a request:
  • Present a summary of contamination activities and activity locations to the joint committee
  • Must consent to a remuneration analysis
Terms:
  • Reference period -> Based on the last 12 months worked
  • Compensation -> 100 % of gross income
  • Duration of compensation -> Number of sick leave days, not exceeding 90 days
  • Grace period to send the request -> 20 weeks following the leave
PATIENTS SEEN OUT OF THE ICU (EXCEPT LE 269 DESIGNATED UNIT)
Eligibility requirements:
  • On-duty physicians in an ICU
  • IC beds outside the ICU
Billing instructions:
  • Use ICU sector and choose EP-3 package EP 3 (9997 or 8896) or fee-for-service
  • For an intubation procedure -> Use code 182
PATIENTS SEEN OUTSIDE THE ICU – IN A LE 269 DESIGNATED UNIT
Eligibility requirements:
  • LE 269 designated ICU
  • ICU beds in a “hot-zone” unit
Billing instructions:
  • Daily choice between the 3 following remuneration modes: LE269 package (see Situation 2, Choice 1) or global package fee EP 3 (9997 or 8896) or fee-for-service
  • Fee-for-service/EP3 choice -> Apply context element #C19 on all services
CLSC AT-HOME INTENSIVE CARE PROGRAM
Eligibility requirements:
  • Be part of a SIAD LE 336 team
  • Medical services provided to patients in the CLSC SIAD program
Billing instructions:
  • Codes 42148 and 42151can be billed even if not all conditions are met
  • Apply context element #DC19 or #C19 according to the situation
ON CALL COVERAGE FOR DUTY FOR INTUBATION OF COVID-19 INFECTED PATIENTS – LE 352
Eligibility requirements:
  • LE 269 designated facility/unit
  • No other coverage for any other sector is allowed
  • The 24 hr ward can be covered by 1, 2 or 3 physicians and may be divided by shifts of 8, 12, or 24 hours. Hours cannot overlap
  • No contract required
  • Physician must be on site at the facility
  • Immediate availabity (within 20 minutes)
Billing instructions:
  • Bill the code pertaining to the correct shift and indicate hours (Ex. : 42177:1200-2400 #DC19) :
    • For 24h coverage -> Code 42176 (900 $)
    • For 12h coverage -> Code 42177 (450 $)
    • For 8h coverage -> Code 42178 (300 $)
  • Add context element #DC19 to the on call duty code
  • Add context element #DC19 or #C19 according to the situation on services rendered to trauma patients
  • IC (clinical intervention) -> Not calculated in the 180 minutes daily maximum if the context element #IC19Intervention clinique effectuée pour l’intubation d’un patient COVID positif durant sa garde is applied.
ON-CALL DUTY
Eligibility requirements:
  • Facility must be on the designated list
  • In an Intermediate resource, Senior’s residence, or GMF
  • The DRMG head must forward the list of nominated physicians
  • No service contract (nomination authorizes billing)
  • Wait until the designation process is completed and for the facility to be listed before submitting your claims
Billing instructions:
  • Choose billing code (codes majorés, réguliers ou réduits) as per the (EP38 )
  • On call coverage -> Add context element #DC19 on the code
  • Services rendered -> Add modidfier #DC19 ou #C19 according to the situation
  • Simultanuous wards (same facility number) -> Add context element #GS
HEAD OF DEPARTMENT OR NOMINATED PHYSICIAN
Eligibility requirements:
  • Coordinating activities related to COVID-19
  • Can be performed remotely
  • Physician must be designated
  • Contract may be required
  • The annual hour bank will be adjusted
Billing instructions:
  • 2 package per hour, Apply #DC19 and bill at concerned service dates
    • DRMG head (code 19906)
    • Coord. physician (code 19103)
    • General medicine clinical department head (code 19064)
    • CHSGS ER department head or his/her assistant (code 19040)
  • Protocol of agreement -> Use hourly rate code 103324
  • GMF/GMF-R head -> Use hourly rate code 72101with SECTOR 47
  • Designated CDÉ/SNT/Unit LE 269 leader -> CISSS/CIUSSS instit. number and use hourly rate code 103324
  • Unmerged CHSLD -> Bill EIT (code 15621 ) with context element #DC19
  • CISSS/CIUSSS/Nord-du-Québec/Nunavik/Baie-James
    • HR code 49342 Participation à une réunion –COVID-19
    • HR code 49343 Exécution d'un mandat – COVID-19
OTHER PHYSICIANS
Eligibility requirements:
  • Coordinating activities related to COVID-19
  • Can be performed remotely
Billing instructions:
  • 2 package per hour apply context element #DC19 and bill specific service dates:
    • CHSGS ER department (codes 19883 to 19888)
  • GMF -> context
    • Use hourly rate code 72101 while respecting the allowed bank of hours
    • If hourly rate code 72101, allowance is exceeded, check with DRMG to be remunerate

New context elements >

Élement de ContextDescription
DC19Service rendu à distance dans le cadre de la COVID-19
TTTéléconsultation par voie téléphonique
TVTéléconsultation par visioconférence
C19Service rendu en présence du patient dans le cadre de la COVID-19
IC19Intervention clinique effectuée pour l’intubation d’un patient COVID positif durant sa garde

New diagnostics codes >

Diagnostics linked to the COVID-19
  • U071 – COVID-19, virus identifié
  • U072 – COVID-19, virus non identifié

Other measures >

Quarterly cap (Plafond trimestriel)
  • Quarterly cap -> Remuneration for services performed in a clinic dedicated to COVID-19 is excluded from the gross quarterly income calculation for the determined period.
Attendance rate (Taux d’assiduité)
  • Attendance rate -> A patient visit performed in the context of the Lettre d’entente 269 is excluded from the attendance rate calculation.
PREM
  • From March 1st to June 30th 2020, the number of work days performed outside of the sub territory or region stated on your compliance notice/contract, including days work as support needed due to non adequate medical staffing, will be excluded from the calculation of the lowered remuneration during this period.

    This measure does not apply to the physician who practices without a compliance contract or exemption notice.

    As of July 1st 2020, the temporary interruption of lowered remuneration will be evaluated on a case by case basis at the COGEM’s request. The agreements made prior to July 1st 2020 hold.

Expired RAMQ coverage / non eligible patients >

For patients seen in person (for testing or related to COVID-19)
Patient participating in a private insurance plan:
  • Submit claim to the private insurance company
Patient without a RAMQ card and not participating in a private insurance plan:
  • Chose option « Patient requérant des soins urgents »
  • Input last name, first name, sex, date of birth and address of the patient
  • Add context element #C19
Expired RAMQ coverage:
  • Submit claim with the patient’S HIN (NAM)
  • Add context element #C19
For patients seen remotely (related to COVID-19)
Expired RAMQ coverage:
  • Submit claims with the patient’S HIN (NAM)
  • Add context element #C19
To obtain all possible scenarios Click here to consult the « Couverture offerte par le Québec pour le dépistage et les soins relatifs à la COVID-19 »