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)
1. Physicians performing services remotely
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)
2. Physician working in a designated Unit, SNT or CDÉ LE 269 (Except population-based WALK-IN)
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)
- 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
Services rendered on SATURDAY BETWEEN 16:00 and 24:00 designated facility 0XXX7: - 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 $251 (4 hours) billable per day at all facilities/units except a CDE
- Context element -> Apply #CDE in a CDE facility
- Billing format -> code:minutes:start-end (For Example )
Services rendred between 16h(4pm) et 24h(midnight), ON A HOLIDAY, in a CDE facility- Line 1 = 19680:120:1600-1800
- Line 2 = 19681:240:1600-2000
- Line 3 = 19680:360:1800-2400
- Line 4 = 19683:120:1600-1800#CDE
- Line 5 = 19683:360:1800-2400
- SERVICES RENDERED -> No other remuneration allowed
For more information on how these terms apply to you specifically, please visit the COVID-19 Q&A section on the FMOQ website or get in touch with our experts.
Choice 2
MAINTAINING THE FEE-FOR-SERVICE OR MIXED MODE:
Eligibility requirements:
- LE 269 designated facility/Unit
*The translated terms are used in the sections below.
Billing instructions:
- Services/package fees -> Bill the package fees/services as usual with context element #C19
- To compensate for Frais de cabinet (office fees), Clinique externe, (outpatient clinic, CLSC or GMF-U) -> The following supplements can be billed in addition to the visit:
Eligible examination | Billing code | Rate ($) |
---|---|---|
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:
- LE 269 designated facility/Unit
Billing instructions:
- Activity code XXX346 Services cliniques – COVID-19.
- Consultation register -> Not required
3. Sans rendez-vous populationnel (Population-based WALK-IN) in a GMF-R, GMF-U, GMF clinic or GMF-designated facility LE 269
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
- Forfait horaire (Hourly package) -> Code 19680 ($186.15 / hour)(Limited to one doctor on an hourly basis)
- In GMF-U or GMF (CLSC) facility:
- Choice at an hourly rate, per full hour:
- Mixed mode or live mode -> Code 42183 ($ 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
- Choice at an hourly rate, per full hour:
4. Physicians on preventive leave of absence / Isolation measures / Sick leave
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
5. Physicians working in an ICU
*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
6. Physician De garde en disponibilité (On-call duty), linked to the pandemic
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
7. Physicians participating in coordination activities related to COVID-19
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
(services rendered in presence of the patient)
(Clinical intervention to intubate a covid positive patient during on call coverage)
(services rendered in a populatin based wide access walk-in clinic)
(services rendered as part of a CLSC at home care program.)
(services rendered in a private residence for elderly or in a intermediary resource )
New diagnostics codes
Diagnostics linked to the COVID-19
- U071 – COVID-19, virus identifié
- U072 – COVID-19, virus non identifié
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)
- Submit claims with the patient’S HIN (NAM)
- Add context element #C19