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

Update 2020-11-11

Here are the latest updates in regard to 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.

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

1. Physicians performing services remotely

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

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
  • #TV (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.

At-home visit

Package for office fees/expenses

  • Can be billed as usual

Communications (codes 15841 to 15846)
  • No limitation
  • Not restricted to the number of registered patients (- 500 patients -> use 15841 or 15844)

Discussions with family

  • Disabled/immature patient -> Bill the services as if patient were seen in person

CLSC home care program

  • Codes 15900, 15901, 15905, 15906 and 15907 are billable if equivalent to a follow-up visit

CHSLD/READAP/PSYCH. visits

  • VSE (codes 15617, 15628, 8913 or 8942) Billable if equiv. to complex walk-in visit
  • VSC (codes 15616, 15627 ou 8933) -> Billable if equiv. to minor walk-in visit

ER unit/outpatient

  • 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
Daily choice 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

Eligibility requirements:
  • Physician in contact with a suspected or confirmed Covid-19 patient
  • OR
  • Emergency Clinic /RI/RPA/CHSLD in a « Red zone » or a « Orange zone » (Each of those facility/unit should be designated LE 269. If not, the person in charge has the possibility to send a request to add the facility to the LE 269 designated list.)
  • LE 269 designated facility/unit
  • Billable during operation hours of the CDÉ/Unit
  • Not billable for remote visits
  • Not billable for remote visits
    • 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 (Use fee for service (type “forfait”)):
  • Rate increase -> Applies to unfavourable hours time slots (code 19680)
    • % 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.
    • Home Support Program in CLSC eligible under certain conditions:
      • - Count the number of minutes of the visit for patients infected or suspected of Covid-19 only
      • - Apply context element #SD19
    • Bill code:minutes:beginning time-end time (For example )
  • Code 19683 ($35.30/hour) -> Unfavourable hours Supplement
    • Billable any day of the week from 18h(6pm) to 24h(midnight)
    • USI -> (On week-ends and public holidays) Can be billed from 00:00 to 24:00
    • CDÉ -> Applicable week nights from 18h00 (6pm) to 24h00 (midnight)/on weekends and holidays during operating hours. If billed earlier than 18h00 (6pm), add context element #CDE
    • A doctor practicing in the emergency room or in GMF-R can claim his usual unfavorable hours supplements when the 19683 package not applicable.
    • (For example)
  • Code 19681 ($62.75/hour) -> Office fees/expenses IN CDE package (Physician assuming office expenses for his usual clinic)
    • Bill code:minutes:hredébut-hrefin
    • Apply #CDE(For example)
  • SERVICES RENDERED -> No other remuneration

Must the mode be maintained all day?

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.

Must the consultation register be filled for patients seen?

No

Can a physician cover both the “hot” and “cold” zones?

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.

If the physician is not on the "hot-zone" ward list, but rather covers the "cold-zone" in a designated sector, how should he/she bill?

He/she should bill using the usual remuneration mode.

Can CNESST reports be billed together with LE 269 packages?

The time used to fill the report must be deducted from code 19680 and the report must been billed outside the period.
  • 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
  • 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 examination Billing code Rate ($)
Ordinary exam, or walk-in minor visit, all ages (billing code 5, 8882, 8883, 15765, 15766, 15767, 15768, 15769, 15770, 15771, or 15772) 15300 7,65
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) 15301 13,35
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
The context element #C19 Service rendu en présence du patient dans le cadre de la COVID-19 must applied to all services and package fees in addition to the usual context elements.
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
  • 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
Tip: It is more profitable to choose the fixed rate per hour package ($186.15/hour) over the regular hourly rate ($99.48/hour).
Tip: To calculate what is more advantageous, you can compare the amounts of your schedules in your archives and simulate an hourly flat rate bill.
WALK-IN PERIODS ONLY

Eligibility requirements:
  • Doctor assigned to the population-based walk-in clinic
  • Establishment designated by the parties to ensure access to registered or unregistered customers
  • Package limited to one doctor on an hourly basis
  • Daily choice at hourly rates OR maintenance of the usual mode of remuneration
  • Method of remuneration for service, mixed or fixed fees combined with mixed

Billing instructions:
  • Unfavorable hours -> Claim on a separate line from 24:00, 08:00 and 18:00 (codes 19680, 42183 or 42184)
  • In GMF-R (except CDE), GMF-U clinic (5XXXX) or GMF clinic :
    • Choice of hourly package, per full hour -> Code 19680 ($186.15 / hour)
      • - Bill code: minutes:start time-end time
      • - Add context #SRVP
    • Office fees -> Codes 19928 or 19929 if normally entitled, depending on the number of patients seen. Add context element #SRVP
    • Unfavorable GMF-R hours -> Code 19893 between 18:00 and 22:00 on weekdays/Code 19894 between 08:00 and 22:00 Federal and public holidays. Example:

      • Service SUNDAY between 08:00 and 16:00 GMF-R 5XXXX establishment designated SRVP :
      • Start time - line 1 = 8:00/Code = 19680:480: 0800-1600#SRVP
      • Start time - line 2 = 8:00/Code = 19929#SRVP (+20 pts. seen)
      • Start time - line 3 = 8:00/Code = 19894:480:0800-1600
  • In GMF-U or GMF (CLSC) establishment:
    • Choice at an hourly rate, per full hour:
      • - Choice at an hourly rate, per full hour: 42183 ($ 143 / hour)
      • - ($ 143 / hour) 42184 ($ 37.80 / hour)
        • - Bill code: minutes:start time-end time
        • - Add context #SRVP Example:

          • Service SUNDAY between 12:00 and 20:00, GMF-U establishment designated SRVP - mixed mode:
          • - Start time - line 1 = 12:00/Code = 42183:360:1200-1800#SRVP
          • - Start time - line 2 = 18:00/Code = 42183:120:1800-2000#SRVP
  • SERVICES RENDERED -> No other remuneration allowed. Update your consultation registry
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
The physician who accepts to be reassigned and who’s income is lower than the last 12 months could be compensated for the difference.
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 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

Two (2) responsibility premiums will be calculated and automatically paid to the physician billing the 19680 package in an intensive care unit.
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 42151 can 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 #IC19 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 (increased, regular or decreased codes) as per the (EP38)
    • Simultanous on call coverage (same facility number) add context element #GS
    • Add context element #DC19 to on call coverage codes
  • Services rendered -> Add element #DC19 or #C19 according to the situation
RESPONDING PHYSICIAN

Eligibility requirements:
  • Doctor nominated by the parity committee (comité paritaire)
  • Acts as a responding physician or assists
  • Coordinates organizational activities related to COVID-19

Billing instructions:
  • Weekdays, Monday to Friday except bank holidays, from 24:00 (midnight) to 08:00 and from 20:00 to 24:00 (midnight) -> Code 42185
  • Saturday, Sunday or holidays from 24:00-24:00 (midnight to midnight) -> Code 42186
    • Bill code: minutes:start time-end time
  • Communication with specialist or general practitioner -> Codes 15841, 15842 or 15843 for each communication
    • Add #TT or #TV depending on the communication mode
HEAD OF DEPARTMENT OR NOMINATED PHYSICIAN

Eligibility requirements:
  • Coordinating activities related to COVID-19
  • Can be performed remotely
  • Physician must be designated or nominated
  • 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)
    • Activities carried out on behalf of a national body (codes 19797, 19798 or 19799)
  • Protocol of agreement -> Use hourly rate code103324
  • GMF/GMF-R head -> Use hourly rate code 72101 with 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
    • TH code 49342 Participation à une réunion – COVID-19
    • TH code 49343 Exécution d’un mandat – COVID-19
  • Clinical management of pre-hospital emergency services, other than Montreal and Laval:
    • TH code 225355 Directeur médical régional COVID-19 – Réunion
    • TH code 225358 Directeur médical régional COVID-19 – Exécution d’un mandat
  • Local coordinator of medical staff:
    • TH code 49359 Coordonnateur local d’effectifs médicaux COVID-19 – Réunion
    • TH 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):
    • TH code 16354 Activités rémunérées autres que celles des médecins-escortes (COVID-19)
  • The doctor who acts as local coordinating doctor for the reallocation of medical staff:
    • TH code 49335 Coordonnateur local d’effectifs médicaux (Réunion)
    • TH code 49360 Coordonnateur local d’effectifs médicaux (Exécution d’un mandat)
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

Context elements
Description
DC19
Service rendu à distance dans le cadre de la COVID-19
TT
Téléconsultation par voie téléphonique
TV
Téléconsultation par visioconférence
C19
Service rendu en présence du patient dans le cadre de la COVID-19
IC19
Intervention clinique effectuée pour l’intubation d’un patient COVID positif durant sa garde
CDE
Service rendu en clinique d’évaluation (CDÉ)
SRVP
Service rendu en sans rendez-vous populationnel
SD19
Service rendu dans le cadre du programme de soutien à domicile en CLSC
RPA
Service rendu en résidence privée pour aînés (RPA) ou en ressource intermédiaire (RI)
Diagnostics linked to the COVID-19

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

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.

Continuing Education (Ressourcement)

  • Unused days from 2020 will be carried over to 2020.

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.


Form for level of medical intervention

  • Code de facturation 15618 -> Se facture en RI/RPA désignée ou dans le cadre du programme de soutien à domicile.
    • Add context element #C19
    • In RI/RPA setting, add context element #RPA

Support for pre-hospital emergency care

  • Remote Death Assessment Certificate -> Code 15264 is billed in any emergency room of a CHSGS or CLSC of the on-call network if context #DC19 is applied.
  • Remote medical support -> Code 15259 (with context #DC19 and #TT or #TV) is billed for an emergency service in one of the following regions designated by the MSSS:
    • Capitale-Nationale
    • Mauricie et Centre-du-Québec
    • Estrie
    • Outaouais
    • Lanaudière
    • Montérégie
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 »