Remuneration terms for services rendered during the Covid 19 pandemic GENERAL PRACTITIONERS

This is an overview of all the important information regarding the remuneration terms for services related to the current pandemic. Note that the content of this page may not always be up to date and that a thorough reading of all the infolettres or the Lettre d’entente no 269 published by the RAMQ is necessary to your understanding of these terms.

Make sure to visit the News section on our website, where articles on the latest updates are published regularly.

Lettre d’entente 269 (Letter of Agreement n269) is effective as of February 28, 2020, except for services performed remotely which are effective as of March 16, 2020. Please note that the billing grace period has been temporarily extended to 120 days.

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

Choose 1 or 2 depending on the usual mode
Please note that the context element #DC19 will be automatically added by the software when #TT or #TV is applied.

Choice 1 – USUAL REMUNERATION MODE

À L’ACTE (FEE-FOR-SERVICE) OR MIXED

Billing instructions:

Context elements:

  • #TT Téléconsultation par voie téléphonique (teleconsulting via phone call) (Ex.: 15774#TT)
  • #TV Téléconsultation par visioconférence (teleconsulting via videoconferencing) (Ex.: 15774#TV)

Visits (office / GMF-U / CLSC)

  • Prise en charge (First-time visit) -> Can be billed (An in-person physical exam must be scheduled within 6 months if the patient is non-vulnerable, or 3 months if the patient is vulnerable)
  • Périodique pédiatrique (Pediatric visit) that requires a physical exam -> Cannot be billed
  • Ponctuelle complexe (Complex walk-in visit) that requires a physical exam -> Cannot be billed
  • Prise en charge de grossesse (First-time pregnancy visit) that requires a physical exam -> Cannot be billed
  • Musculo-squelettique (Codes 8775 to 8777) -> Cannot be billed

At-home visit

  • Patient en perte sévère d’autonomie (Severe lost of autonomy visit) that requires a physical exam -> Cannot be billed

Communications (codes 15841 to 15846)

  • No maximum per quarter

CHSLD/READAP/PSYCH. visits

  • Évaluation médicale globale (Global medical evaluation) (code 15615) -> Cannot be billed
  • Visite de suivi exigeant un examen (Visit necessiting a physical exam) (code 15617) -> Cannot be billed
  • Visite d’évaluation en vue de donner une opinion (Consultation) (code 15619) -> Cannot be billed
  • Visite de suivi courant (Regular visit) (code 15616) -> Can be billed

Choice 2 – USUAL REMUNERATION MODE

HOURLY RATE OR FIXED FEE

*The translated terms are used in the sections below.

Eligibility requirements:
  • Physician performing services remotely

Billing instructions:
  • #TT Téléconsultation par voie téléphonique (teleconsulting via phone call) (Ex. : 8877#TT)
  • #TV Téléconsultation par visioconférence (teleconsulting via videoconferencing) (Ex. : 8877#TV)
  • Over the phone -> Use activity code XXX352 Services cliniques à distance par téléphone (pandémie COVID-19)
  • Via videoconference -> Use activity code XXX353 Services cliniques à distance par visioconférence (pandémie COVID-19)
Daily option
Tip: To calculate the better paid rate, you can compare the amounts of your grids in your archives and simulate a LE269 package claim.

Choice 1

LE269 PACKAGE CLAIM

*The translated terms are used in the sections below.

Eligibility requirements:
  • The facility/unit must be in the list of LE 269 designated facilities
  • Region on state of alert GREEN, YELLOW or ORANGE – all facilities
    • Physician must be in contact with a patient suspected or confirmed to have COVID-19
    • Clinique d’urgence (Emergency room) level 2 or 3 -> Restricted to only one physician on a hourly basis
  • OR
  • Region on state of alert RED - Emergency room / Intermediary resource (RI) / Residence for the elderly (RPA) / CHSLD
    • Contact with a patient suspected or confirmed to have COVID-19 not required
    • For others types of facilities -> Physician must be in contact with a patient suspected or confirmed to have COVID-19
    • Can be claimed by more than one physician on a hourly basis at the same facility/unit
  • Clinique d’évaluation (COVID evaluation clinic) (CDE) -> Billable only during the opening hours of the CDE
  • Programme de soutien à domicile en CLSC (CLSC homecare program) -> Billable under certain conditions

Billing instructions:
  • Forfait horaire (Hourly fee) -> 19680 (186.15 $/heure)
    • Billing format -> code:minutes:start-end (For Example)
    Service on a weekday between 08:00 et 16:00 designated facility 0XXX7:
    • Sector = ER
    • Line 1 = 19680:480:0800-1600
  • Horaires défavorables (Unfavourable hours) Supplement -> Code 19683 (35.30$/heure)
    • Weekdays -> Billable from 18h to 24h
    • Weekend / Holidays
      • ICU -> Billable from 0h to 24h
      • CDE -> Billable during the opening hours (#CDE required before 18h)
      • ER -> Billable from 18h to 24h (Code 19953 is billable from 8h to 18h)
      • GMF-R -> Billable from 18h to 24h (Code 19894 is billable from 8h to 18h)
    • Other facilities/units -> Billable from 18h to 24h
    • Billing format -> code:minutes:start-end (For Example)
      • Services rendered on SATURDAY BETWEEN 16:00 and 24:00 designated facility 0XXX7:
      • Sector = ER
      • Line 1 = 19680:240:1600-2000
      • Line 2 = 19680:240:2000-2400
      • Line 3 = 19953:120:1600-1800 or SSDF120:1600-1800
      • Line 4 = 19683:360:1800-2400
  • Frais de cabinet (Office fees) compensation -> 19681 (62.75$/heure)
    • Billable whenever a physician must leave or close their office to cover a LE 269 Covid designated facility/unit
    • Maximum of $251 (4 hours) billable per day at all facilities/units except a CDE
    • Context element -> Apply #CDE in a CDE facility
    • Billing format -> code:minutes:start-end (For Example )
    Services rendred between 16h(4pm) et 24h(midnight), ON A HOLIDAY, in a CDE facility
    • Line 1 = 19680:120:1600-1800
    • Line 2 = 19681:240:1600-2000
    • Line 3 = 19680:360:1800-2400
    • Line 4 = 19683:120:1600-1800#CDE
    • Line 5 = 19683:360:1800-2400
  • SERVICES RENDERED -> No other remuneration allowed

For more information on how these terms apply to you specifically, please visit the COVID-19 Q&A section on the FMOQ website or get in touch with our experts.

Choice 2

MAINTAINING THE FEE-FOR-SERVICE OR MIXED MODE:

Eligibility requirements:

*The translated terms are used in the sections below.

Billing instructions:
  • Services/package fees -> Bill the package fees/services as usual with context element #C19
  • To compensate for Frais de cabinet (office fees), Clinique externe, (outpatient clinic, CLSC or GMF-U) -> The following supplements can be billed in addition to the visit:
Eligible examination Billing code Rate ($)
Examen ordinaire (Ordinary exam), or Visite ponctuelle mineure (Walk-in minor visit), (billing code 5, 8882, 8883, 15765, 15766, 15767, 15768, 15769, 15770, 15771, or 15772) 15300 7,65
Examen complet (Complete exam) for a patient less than 70 years old or Visite ponctuelle complexe (Walk-in complex visit) for a patient less than 80 years old (billing code 56, 15773, 15774, 15775, or 15776) 15301 13,35
Examen complet (Complete exam) for a patient 70 years old or over, or Visite ponctuelle complexe (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:
Billing instructions:
  • Activity code XXX346 Services cliniques – COVID-19.
  • Consultation register -> Not required
Tip: It is more profitable to choose the fixed rate per hour package ($186.15/hour) over the regular hourly rate ($99.48/hour).
SANS RENDEZ VOUS (WALK-IN PERIODS ONLY)

Eligibility requirements:
  • Doctor assigned to the Sans rendez-vous populational (Population-based walk-in clinic)
  • Facility designated by the parties
  • At least 3 slots per hour must be kept open for Sans rendez-vous (walk-ins) only
  • Must be subscribed to RSVQ or another compatible scheduling system
  • Must accept patients from the COVID call centres, from the GACO and from the emergency services

*The translated terms are used in the sections below.

Billing instructions:
  • Daily option – Hourly fee OR regular billing mode
  • In GMF-R, GMF-U clinic or GMF clinic :
    • Forfait horaire (Hourly package) -> Code 19680 ($186.15 / hour)(Limited to one doctor on an hourly basis)
      • Bill code: minutes:start time-end time
      • Context #SRVP
    • Frais de cabinet (Office fees) -> Codes 19928 or 19929 if normally entitled, depending on the number of patients seen. Add context element #SRVP
    • Horaires défavorables (Unfavorable) (GMF-R) -> Code 19893 (For Example ):

      • Service SUNDAY between 08:00 and 16:00 GMF-R 5XXXX establishment designated SRVP :
      • Line 1 = 19680:480: 0800-1600#SRVP
      • Line 2 = 19929#SRVP (+20 pts. seen)
      • Line 3 = 19894:480:0800-1600#SRVP
  • In GMF-U or GMF (CLSC) facility:
    • Choice at an hourly rate, per full hour:
      • Mixed mode or live mode -> Code 42183 ($ 143 / hour)
      • Fixed fee mode combined to mixed mode -> Code 42184 42184 (37.80 $/heure)
      • Bill code: minutes:start time-end time
      • Contexte ->#SRVP (For Example )

        Service SUNDAY between 12:00 and 20:00, GMF-U facility designated SRVP - mixed mode:
        • Line 1 = 42183:360:1200-1800#SRVP
        • Line 2 = 42183:120:1800-2000#SRVP
  • SERVICES RENDERED -> No other remuneration allowed. Update your Registre de consultations (Consultation registry) of the patients seen.
    • 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 Comité paritaire (Joint committee) to receive approval

    Terms:
    • Reassigned physician on hourly rate mode:
      • (Medical tasks) -> Activity code XXX344 Tâches médicales – Retrait préventif
      • (Medico-admin. tasks) -> Activity 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 Comité paritaire (Joint committee) (if not in a COVID clinic)

    How to submit a request:
    • Present a summary of contamination activities and activity locations to the Comité paritaire (Joint committee)
    • Must consent to a remuneration analysis
    Terms:
    • Reference period -> Based on last weeks 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
    • Reassigned physician -> If the remuneration is less than that of the reference period, the physician may be entitled to a fee to cover the difference

    Two (2) responsibility premiums will be calculated and automatically paid to the physician billing the 19680 package in an intensive care unit.
    *The translated terms are used in the sections below.

    EP 3 - PATIENTS SEEN OUT OF THE ICU (EXCEPT LE 269 DESIGNATED UNIT)

    Eligibility requirements:
    • On-duty physicians in an ICU
    • IC beds outside the ICU unit

    Billing instructions:
    • Sector 16 – Unité de soins intensifs (Intensive Care Unit)
    • Services -> EP-3 package(9997 or 8896)
    PATIENTS SEEN OUTSIDE THE ICU – IN A LE 269 DESIGNATED UNIT

    Eligibility requirements:
    • LE 269 designated ICU
    • ICU beds dedicated to COVID-19

    Billing instructions:
    • Daily choice between the 2 following remuneration modes: LE269 package (see Situation 2, Choice 1) or global package fee EP 3 (9997 or 8896)
    • 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 42151 can be billed even if not all conditions are met
    • Context element #DC19 or #C19 according to the situation
    DE GARDE EN DISPONIBILITÉ (ON CALL COVERAGE) FOR INTUBATION OF COVID-19 INFECTED PATIENTS – LE 352

    *The translated terms are used in the sections below.

    Eligibility requirements:
    • LE 269 designated facility/unit
    • 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
    • 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 $)
    • Context elements:
      • #DC19 on the fee
      • #DC19 or #C19 on the services
    • Uncapping the Intervention Clinique daily minutes -> #IC19
    DE GARDE EN DISPONIBILITÉ (ON-CALL DUTY)

    Eligibility requirements:
    • Facility must be on the designated list
    • Physician must be nominated by the head of department

    Billing instructions:
    • Use the billing codes from Entente Particulière 38 (increased, regular or reduced), as per the list
      • Add context element #DC19 to on call coverage codes (For Example )
        • On a weekday between 0h and 24h:
          • Line 1 = 190XX:480:0000-0800#DC19
          • Line 2 = 190XX:480:0800-1600#DC19
          • Line 3 = 190XX:480:1600-2400#DC19
        • On week ends or holidays between 0h and 24h
          • Line 1 = 9XXX:1440:0000-2400#DC19
    HEAD OF DEPARTMENT OR NOMINATED PHYSICIAN

    *The translated terms are used in the sections below.

    Eligibility requirements:
    • Can be performed remotely
    • Physician must be designated or nominated

    Billing instructions:
    • 2 packages per hour, (Add context element #DC19)
      • DRMG head (code 19906)
      • Coord. physician (code 19103)
      • Head / Assistant head of the general medicine clinical department -> code 19064
      • Head / Assistant head of the emergency department -> code 19040
      • Other physicians in the emergency department -> codes 19883 to 19888
      • Activities carried out on behalf of a national body (codes 19797, 19798 or 19799)
      • CHSLD not merged with a hospital -> code 15261
    • GMF/GMF-R head -> Use hourly rate code 72101 with SECTOR 47
    • Designated CDÉ/SNT/Unit LE 269 leader or Protocole d’accord (Protocol of agreement) -> Activity code 103324
    • CISSS/CIUSSS/Nord-du-Québec/Nunavik/Baie-James
      • Activity code 49342 Participation à une réunion – COVID-19
      • Activity code 49343 Exécution d’un mandat – COVID-19
    • Local coordinator of medical staff:
      • Activity code 49359 Coordonnateur local d’effectifs médicaux COVID-19 – Réunion
      • Activity code 49360 Coordonnateur local d’effectifs médicaux COVID-19 – Exécution d’un mandat
    • Services provided as part of the aeromedical evacuation system in Quebec (ÉVAQ) -> Activity code 16354
    • The doctor who acts as local coordinating doctor for the reallocation of medical staff:
      • Activity code 49335 Coordonnateur local d’effectifs médicaux (Réunion)
      • Activity code 49360 Coordonnateur local d’effectifs médicaux (Exécution d’un mandat)

    New context elements

    Context element
    Description
    DC19
    Service rendu à distance dans le cadre de la COVID-19   (services rendered remotely)
    TT
    Téléconsultation par voie téléphonique   (teleconsulting via phone call)
    TV
    Téléconsultation par visioconférence   (teleconsulting via videoconferencing)
    C19
    Service rendu en présence du patient dans le cadre de la COVID-19

    (services rendered in presence of the patient)

    IC19
    Intervention clinique effectuée pour l’intubation d’un patient COVID positif durant sa garde

    (Clinical intervention to intubate a covid positive patient during on call coverage)

    CDE
    Service rendu en clinique d’évaluation (CDÉ)   (services rendered at a Covid evaluation clinic)
    SRVP
    Service rendu en sans rendez-vous populationnel

    (services rendered in a populatin based wide access walk-in clinic)

    SD19
    Service rendu dans le cadre du programme de soutien à domicile en CLSC

    (services rendered as part of a CLSC at home care program.)

    RPA
    Service rendu en résidence privée pour aînés (RPA) ou en ressource intermédiaire (RI)

    (services rendered in a private residence for elderly or in a intermediary resource )

    Diagnostics linked to the COVID-19

    • U071 – COVID-19, virus identifié
    • U072 – COVID-19, virus non identifié

    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)

    • 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 »