Remuneration terms for services performed in an intensive care unit with patients suffering from or suspected of having COVID-19 (SARS-CoV-2)

To follow-up on the receipt of the infoletter on May 1, 2020 concerning the terms of remuneration for USI-COVID-19, here is some information that will be useful for you to fully understand the new Lettre d'entente 239.
The RAMQ is ready to receive your billing. You have 120 days starting May 1st to invoice your services retroactively to March 13, 2020.
If you wish to find information about your situation, please check the following hyperlinks:

Five situations COVID-19

1. Taking charge of a unit

Taking charge of a unit

Billing codes:

Lump-sum codes for taking charge of a unit:

CODESDESCRIPTIONRATE ($)
42158Forfait de prise en charge de l’unité COVID-19 de 8h à 16h800$
42159Forfait de prise en charge de l’unité COVID-19 de 16h à 20h400$
42160Forfait de prise en charge de l’unité COVID-19 de 20h à 24h 400$
42161Forfait de prise en charge de l’unité COVID-19 de 24h à 8h 800$
Procedures included (Appendix to the pricing of procedures included in the lump-sum for support to taking charge of a unit in Appendix 29)

Rules:
  • Physician and institution designated in Appendix 29
  • Have at least two beds with patients suffering from or suspected of having COVID-19
  • Presence of an intensivist on site, round the clock, because the clinical condition of some patients in the unit requires it, according to the clinical evaluation of the intensivist in charge of the unit
  • Lump-sum fees are mutually exclusive for one period (Appendix 29)
  • A maximum of 12 hours of billable lump-sum fee, per physician, except in cases designated by the negotiating parties
  • A maximum of one lump-sum fee, per period, per COVID-19 unit
  • A maximum of one lump-sum fee per physician, per period
  • Surcharge of 20% for being on location between 8 p.m. and 8 a.m. everyday and between 8 a.m. and 8 p.m. on weekends and public holidays
Taking charge of a patient

Billing codes:

Lump-sum codes for taking charge of a patient:

CODESDESCRIPTIONRATE ($)
42164Forfait de prise en charge d’un patient dans une unité COVID-19 de 8 h à 16 h145$
42165Forfait de prise en charge d’un patient dans une unité COVID-19 de 16h à 20h72,50$
42166Forfait de prise en charge d’un patient dans une unité COVID-19 de 20h à 24h 72,50$
42167Forfait de prise en charge d’un patient dans une unité COVID-19 de 24h à 8h 145$
Procedures included (Appendix to the pricing of procedures included in the lump-sum for support to taking charge of an intensive care patient in Appendix 29)

Rules:
  • Surcharge of 20% for being on location between 8 p.m. and 8 a.m. everyday and between 8 a.m. and 8 p.m. on weekends and public holidays
  • The lump-sum fee can be paid as soon as a patient stays in a COVID-19 ICU
  • Only the physician billing the lump-sum fee for taking charge a unit is entitled to the lump-sum fee for a patient
  • Maximum of 1 lump-sum, per period, per patient
Fees provided for resuscitation care in cases of cardiac arrest and / or serious and complex situations (code 9403, 9404 and 9405) when performed for any patient of the institution, outside the COVID-19 unit as well as 2nd and 4th stages of extracorporeal membrane oxygenation. Codes (897 and 899) are allowed.
Taking charge of more than one unit

Billing codes:

Lump-sum codes for taking charge more than one unit (midnight to 8 a.m. only)

CODESDESCRIPTIONRATE ($)
42162Forfait de prise en charge de 2 unités COVID-19 de 24h à 8h800$
42163Forfait de prise en charge de 3 unités COVID-19 de 24h à 8h800$
Procedures included (Appendix to the pricing of procedures included in the lump-sum for support to taking charge of a unit in Appendix 29)

Rules:
  • Physician and institution designated in Appendix 29;
  • Have at least two beds with patients suffering from or suspected of having COVID-19
  • Need for the presence of an intensivist on site, round the clock, because the clinical condition of some patients in the unit requires it, according to the clinical evaluation of the intensivist in charge of the unit
  • Lump-sum fees are mutually exclusive for one period (Appendix 29)
  • A maximum of 12 hours of billable lump-sum fee, per physician, except in cases designated by the negotiating parties
  • A maximum of one lump-sum fee, per period, per COVID-19 unit
  • A maximum of one lump-sum fee per physician, per period
  • Surcharge of 20% for being on location between 8 p.m. and 8 a.m. everyday and between 8 a.m. and 8 p.m. on weekends and public holidays.
Taking charge of a patient

Billing codes:

Lump-sum codes for taking charge more than one COVID-19 ICU between midnight and 8 a.m.

CODESDESCRIPTIONRATE ($)
42168Forfait de prise en charge d’un patient dans une unité COVID-19 de 24h à 8h, pour les patients 1 à 12145$
42169Forfait de prise en charge d’un patient dans une unité COVID-19 de 24h à 8h, pour les patients 13 à 2472,50$
42170Forfait de prise en charge d’un patient dans une unité COVID-19 de 24h à 8h, pour les autres patients 36,25$
Procedures included (Appendix to the pricing of procedures included in the lump-sum for support to taking charge of an intensive care patient in Appendix 29)

Rules:
  • Surcharge of 20% for being on location between 8 p.m. and 8 a.m. everyday and between 8 a.m. and 8 p.m. on weekends and public holidays
  • The lump-sum fee can be paid as soon as a patient stays in a COVID-19 ICU.
  • Only the physician billing the lump-sum fee for taking charge a unit is entitled to the lump-sum fee for a patient.
  • Maximum of 1 lump-sum, per period, per patient.
Fees provided for resuscitation care in cases of cardiac arrest and / or serious and complex situations (code 9403, 9404 and 405) when performed for any patient of the institution, outside the COVID-19 unit as well as 2nd and 4th stages of extracorporeal membrane oxygenation (codes 897 and 899) are allowed.
Billing codes:

Lump-sum codes for taking charge of one unit:

CODESDESCRIPTIONRATE ($)
42171Forfait dans un contexte de débordement, par période complète de 15 minutes (maximum de 16 unités)52,75$
42163Forfait de prise en charge de 3 unités COVID-19 de 24h à 8h800$


Example : 8 :00 : 42171 :0800-0900
Procedures included (Appendix 29)

Rules:
  • In this context, the supporting physician cannot bill the lump-sum fee for taking charge of a patient;
  • Surcharge of 20% for being on location between 8 p.m. and 8 a.m. everyday and between 8 a.m. and 8 p.m. on weekends and public holidays.
  • Enter the service start and finish time. The service start time must be 8 a.m., 4 p.m., 8 p.m. or midnight.
  • Maximum of 4 hours, per period, per physician;
  • Applies to the physician in charge of the unit and who must stay supporting
Institution:
  • In lieu of the lump-sum for taking charge of a unit of Appendix 29
Billing codes:

Lump-sum codes for taking charge of a unit (at least 5 occupied beds)

CODESDESCRIPTIONRATE ($)
42172Forfait de 4 heures complétées pour un médecin réaffecté à l’unité COVID-19844$
42173Forfait horaire pour un médecin réaffecté à l’unité COVID-19, par période de 60 minutes complétées après un premier 4 heures d’activités211$


Example: 08:00 : 42171 :0800-0900 et 12:00 : 42173 :1200-13000
Procedures included (Appendix 29)

Rules:
  • The supporting physician is entitled to a lump-sum fee for a completed 4-hour presence at a COVID-19 ICU
  • Billing code 42172 can only be used to bill for the first 4 hours in a day. The next hours must be billed using code 42173
  • Maximum 24 hours in total, per COVID-19 unit, and a maximum of 12 hours, per physician, per day are allowed
  • Enter the service start and finish time
  • No lump-sum fee for taking charge a patient is allowed
Institution:
  • In lieu of the lump-sum fee for taking charge a unit of Appendix 29
Billing codes:

Codes de forfait de prise en charge de l’unité (au moins 7 lits occupés):

CODESDESCRIPTIONRATE ($)
42174Forfait de 4 heures complétées pour un médecin réaffecté à l’unité COVID-19844$
42175Forfait horaire pour un médecin réaffecté à l’unité COVID-19, par période de 60 minutes complétées après un premier 4 heures d’activités211$


Example: 08:00 : 42174 :0800-1200 et 12:00 : 42175 :1200-1300
Procedures included (Appendix 29)

Rules:
  • The supporting physician is entitled to a lump-sum fee for a completed 4-hour presence at a COVID-19 ICU
  • Billing code 42174 can only be used to bill for the first 4 hours in a day. The next hours must be billed using code 42175
  • Maximum 16 hours in total, per COVID-19 unit, and a maximum of 12 hours, per physician, per day are allowed
  • Enter the service start and finish time
  • Lump-sum can be billed between 8 a.m. and midnight
  • No lump-sum fee for taking charge a patient is allowed
Institution:
  • In lieu of the lump-sum fee for taking charge a unit of Appendix 29

Only the intensivist specialists designated in Appendix 29 can avail themselves of the terms of Lettre d'entente 239, with the exception of the specific situation referred to in articles 5.2 (first reassigned physician) and 5.3 (second reassigned physician) of said Lettre d'entente.

The targeted intensive care units must meet the three following conditions:

  • Be designated as per article 3.3 of Appendix 29 ( Brochure #1 / annexe 29 / RAMQ )
  • Have at least two beds with patients suffering from or suspected of having COVID-19
  • Presence of an intensivist on site, round the clock, because the clinical condition of some patients in the unit requires it, according to the clinical evaluation of the intensivist in charge of the unit

A physician who takes charge of a COVID-19 intensive care unit is entitled, as long as he or she ensures a presence on site, to a lump-sum fee for taking care of a unit.

This lump-sum is payable in lieu of the lump-sum fee for taking care of a unit provided for in article 5.1 of Appendix 29 ( Brochure #1 / annexe 29 / RAMQ )

The specialist billing the lump-sum fee for taking care of a COVID-19 unit is entitled to a 20% surcharge for being present on site.

  • Between 8 p.m. and 8 a.m. everyday
  • Between 8 a.m. and 8 p.m. on weekends and public holidays
1 - Lump-sum fee for taking charge of a unit

CODESDESCRIPTIONRATE ($)
42158Forfait de prise en charge de l’unité COVID-19 de 8h à 16h800$
42159Forfait de prise en charge de l’unité COVID-19 de 16h à 20h400$
42160Forfait de prise en charge de l’unité COVID-19 de 20h à 24h 400$
42161Forfait de prise en charge de l’unité COVID-19 de 24h à 8h 800$

2 - Lump-sum fee for taking charge of more than one COVID-19 unit

Between midnight and 8 a.m., a specialist may take charge of more than one COVID-19 unit in one location, up to a maximum of three units. He or she has then access to the lump-sum fee for taking charge of the patients in the COVID-19 units that he or she takes charge of.

CODESDESCRIPTIONRATE ($)
42162Forfait de prise en charge de 2 unités COVID-19 de 24h à 8h800$
42163Forfait de prise en charge de 3 unités COVID-19 de 24h à 8h800$

Limitations to the unit’s lump-sum fee:

The lump-sum fees of this current Lettre d’entente and those of Appendix 29 are mutually exclusive for any given 24-hour period starting at 8 a.m.According to this current Lettre d’entente, taking charge of a unit starts at 8 a.m.

When the physicians in charge of an intensive care unit switch from the remuneration provided for in Appendix 29 to that provided for in this Lettre d'entente, the coverage for Appendix 29 is then 25 hours and stretches until 8 a.m. On the other hand, when the physicians in charge of an intensive care unit switch from the remuneration provided for in this Lettre d'entente to that provided for in Appendix 29, the coverage of Appendix 29 is then 23 hours and starts at 8 a.m. These two situations do not affect the expected remuneration.

You can bill a maximum of 12 hours of lump-sum fees, per physician, per day, except in cases designated by the negotiating parties.

In addition, a maximum of one lump-sum fee, per period, per COVID-19 unit and of one lump-sum fee per physician, per period are allowed.

Only the physician billing the lump-sum fee for taking charge a COVID-19 unit is entitled to the lump-sum fee for taking charge of a patient, for all the patients hospitalized in this unit.

In addition, a physician who receives a lump-sum fee for taking charge of a COVID-19 unit cannot claim other RAMQ fees for the services he/she provides to any patient in the institution during the period, except:

  • The lump-sum fee for taking charge of a patient in a COVID-19 unit
  • Fees provided for resuscitation care in cases of cardiac arrest and / or serious and complex situations (codes 09403, 09404 and 09405) when performed for any patient of the institution, outside the COVID-19 unit
  • 2nd and 4th stages of extracorporeal membrane oxygenation (codes 00897 and 00899)

Finally, in the COVID-19 unit, no physician can bill the diagnostic and therapeutic procedures included in the lump-sum fee for taking charge of a unit, listed in the appendix to Appendix 29. In addition to these services, remuneration is provided for assisted mechanical ventilation care (codes 00900 , 00927 , 00928 , 00990 , 00991 , 41029 and 41030), evaluation and preparation for the ECMO (code 00803) and maintenance of extracorporeal support, by quarter of hour (code 00898).

Procedures included (Appendix to the pricing of procedures included in the lump-sum fee for taking charge of a unit in Appendix 29)
Brochure #1 / annexe 29 / RAMQ

00301 Cathétérisme veine ombilicale, incluant le prélèvement
00307 Cathétérisme artère ombilicale : mise en place et maintien du cathéter ou son remplacement
00276 Drainage thoracique fermé par pleurotomie
00277 Drainage thoracique fermé par pleurotomie, pleurodèse, supplément
00489 Cardioversion électrique ou défibrillation
00530 Cathéter électrode de stimulation intracardiaque temporaire
00573 Tamponnade œsophage-gastrique par tube ballon
00574 Tamponnade œsophage-gastrique : supervision par jour
00582 Ponction abdominale pour fins diagnostiques ou thérapeutiques
00597 Ponction péricardique
00611 Ponction : vessie
00615 Traitement de pneumothorax : ponction évacuatrice
00616 Traitement de pneumothorax : aiguille et drainage continu
00350 ECG dynamique (bande de 24 heures)
*** Insertion d'un cathéter dans la veine-cave : patient de + de 16 ans
*** (voir actes codés 00903, 00994, 09306)
*** Insertion d'un cathéter dans la veine-cave : patient de - de 16 ans
*** (voir actes codés 00902, 00993, 09305)
00343 Insulinothérapie intensive à doses multiples et variables, initiation ou vérification du traitement, par patient, maximum 4 par patient, par période de 12 mois
09316 Insulinothérapie : perfusion continue d'insuline, par jour
09334 Mise en place d'un cathéter péricardique
09335 Administration de médicaments dans un cathéter péricardique
09418 Ponction pleurale

NOTICE ** Enter the start time for all services performed on the same day as a lump-sum fee for taking charge in a COVID-19 unit.

A physician who takes charge of a patient in a COVID-19 intensive care unit is entitled, as long as he or she ensures a presence on site, to a lump-sum fee for taking charge of a patient.

This lump-sum fee is paid in lieu of the lump-sum fee for taking charge of a patient provided in the Tableau de la tarification des forfaits dans les unités de soins intensifs of Appendix 29. ( Brochure #1 / annexe 29 / RAMQ )

This lump-sum fee can be paid as soon as a patient stays in a COVID-19 ICU.
The specialist billing the lump-sum fee for taking charge of a patient in a COVID-19 unit is entitled to a 20% surcharge for being on location:

  • Between 8 p.m. and 8 a.m. everyday
  • Between 8 a.m. and 8 p.m. on weekends and public holidays
1 - Lump-sum fee for taking charge of a patient in a unit

CODESDESCRIPTIONRATE ($)
42164Forfait de prise en charge d’un patient dans une unité COVID-19 de 8 h à 16 h145$
42165Forfait de prise en charge d’un patient dans une unité COVID-19 de 16h à 20h72.50$
42166Forfait de prise en charge d’un patient dans une unité COVID-19 de 20h à 24h 72.50$
42167Forfait de prise en charge d’un patient dans une unité COVID-19 de 24h à 8h 145$

2 - Lump-sum fee for taking charge of a patient when taking charge of more than one COVID-19 ICU between midnight and 8 a.m

CODESDESCRIPTIONRATE ($)
42168Forfait de prise en charge d’un patient dans une unité COVID-19 de 24h à 8h, pour les patients 1 à 12145$
42169Forfait de prise en charge d’un patient dans une unité COVID-19 de 24h à 8h, pour les patients 13 à 2472.50$
42170Forfait de prise en charge d’un patient dans une unité COVID-19 de 24h à 8h, pour les autres patients36.25$

Limitations to the lump-sum for taking charge of a patient:

A maximum of one lump-sum per period per patient can be billed. The physician receiving such a lump-sum cannot receive other fees from the RAMQ for the services performed for any patient of the institution during this period, except:

  • The lump-sum fee for taking charge of a COVID-19 unit
  • Fees provided for resuscitation care in cases of cardiac arrest and / or serious and complex situations (Codes 09403, 09404 and 09405) when performed for any patient of the institution, outside the COVID-19 unit
  • 2nd and 4th stages of extracorporeal membrane oxygenation 00897 and 00899).

Only the physician billing the lump-sum fee for taking charge of a COVID-19 unit is entitled to the lump-sum fee for taking charge of a patient.
Finally, when billing a lump-sum fee for taking charge of a patient in a COVID-19 unit, no physician can bill the diagnostic and therapeutic procedures listed in article 4.4 Appendix 29 when they are performed on the unit’s location. In addition to these services, remuneration is provided for assisted mechanical ventilation care (codes 0940300900, 00927, 00928, 00990, 00991, 41029 and 41030), evaluation and preparation for the ECMO (code 00803) and maintenance of extracorporeal support, by quarter of hour (code 00898).

Procedures included (Appendix to the pricing of procedures included in the lump-sum fee for taking charge of a patient in the ICU in Appendix 29)
Brochure #1 / annexe 29 / RAMQ

00148 Aspiration duodénale ou intestinale
00149 Aspiration de l'estomac ou de l'oesophage
00302 Cathétérisme vésical d'urgence
00336 Dissection incluant ponction ou insertion de cathéter : artérielle (périphérique)
00337 Dissection incluant ponction ou insertion de cathéter : veineuse
08458 Analyse de saturation en oxygène
00432 Injection de médicament par intubation trachéobronchique
00639 Cathétérisme cardiaque droit et/ou artère pulmonaire
00647 Exsanguino-transfusion (chacune)
00777 Insertion d'un cathéter intra-osseux pour perfusion en situation d'urgence
00522 Lavage gastrique (intoxication médicamenteuse ou alimentaire)
00585 Ponction artérielle pour prélèvement sanguin
00654 Lavage gastrique, eau glacée pour hémorragie
00751 Drainage veine fémorale ou jugulaire
00901 Cathétérisme avec cathéter de Swan Gantz incluant la visite faite au cours des 30 jours précédents, le cas échéant
09304 Cathétérisme avec cathéter de Swan Gantz
Aucun médecin autre que celui qui reçoit le forfait de prise en charge d'un patient ne peut recevoir une rémunération pour la dispensation de ces PDT à l'égard de ce patient, sauf à l'égard des procédés diagnostiques et thérapeutiques suivants, lorsqu'ils sont rendus dans une unité de soins intensifs pédiatriques :
00901 Cathétérisme avec cathéter de Swan Gantz incluant la visite faite au cours des 30 jours précédents, le cas échéant
09304 Cathétérisme avec cathéter de Swan Gantz
00336 Dissection incluant ponction ou insertion de cathéter : artérielle (périphérique)
00337 Dissection incluant ponction ou insertion de cathéter : veineuse

NOTICE ** Enter the start time for all services performed on the same day as a lump-sum fee for taking charge in a COVID-19 unit.
4.1 Lump-sum fee for support to taking charge of a unit in a context of overflow (article 5.1)

The physician who was in charge of the COVID-19 unit and who remains in a COVID-19 unit following a request for support from his or her colleague in the context of an overflow may avail him/herself of the following terms of remuneration per additional quarter hour of on-site presence, for a maximum of 4 hours.

In this context, the physician who remains in support cannot bill a lump-sum fee for taking charge of a patient. This extension cannot be used for transferring care from one physician to another.

The specialist who remains in a COVID-19 ICU in an overflow context is entitled to a 20% surcharge for being on location:

  • Between 8 p.m. and 8 a.m. everyday
  • Between 8 a.m. and 8 p.m. on weekends and public holidays
NOTICE ** enter the service start and finish time. The service start time must be 8 a.m., 4 p.m., 8 p.m. or midnight.
The lump-sum fees billed between midnight and 8 a.m. will not be automatically increased when billed. They will be revised by the RAMQ during the month of May in order to grant you the surcharge to which you are entitled. No action is required from you.
Lump-sum fee for support to taking charge of the COVID-19 unit in a context of overflow:

CODESDESCRIPTIONRATE ($)
42171Forfait dans un contexte de débordement, par période complète de 15 minutes (maximum 16)52.75$


4.2 Lump-sum fee for support to taking charge of the unit by a reassigned physician (article 5.2 to 5.4)

The following terms apply to the physician who is reassigned to a COVID-19 ICU in order to offer support to the intensivist who is in charge of the unit.

The physician reassigned to a COVID-19 ICU can only use the terms and conditions provided for in this Lettre d'entente for activities performed in intensive care and cannot bill the lump-sum amounts provided for in Lettre d'entente 238.

The specialist reassigned to a COVID-19 ICU in order to offer support is entitled to a 20% surcharge of his/her lump-sum for being on location:

  • Between 8 p.m. and 8 a.m. everyday
  • Between 8 a.m. and 8 p.m. on weekends and public holidays
The lump-sum fees billed for weekdays between midnight and 8 a.m. will not be automatically increased when billed. They will be revised by the RAMQ during the month of May in order to grant you the surcharge to which you are entitled.

The lump-sum fees billed for weekdays and for which the period billed overlaps 8 a.m. or 8 p.m. will not be automatically increased when billed. They will be revised by the RAMQ after the expiration of the Lettre d’entente in order to grant you the surcharge to which you are entitled.

No action is required from you.


4.2.1 First reassigned physician:

In a COVID-19 unit, if at least five beds in the unit are occupied by patients affected by COVID-19 or suspected of being, a specialist can be reassigned to offer support to the intensivist who is in charge of the unit.

The supporting physician is entitled to a lump-sum fee for a 4-hour activity period completed for which he or she is present in the COVID-19 intensive care unit.

For any participation of more than 4 hours, a fixed rate per hour can be applied for each complete 60-minute period.

CODESDESCRIPTIONRATE ($)
42172Forfait de 4 heures complétées pour un médecin réaffecté à l’unité COVID-19844$
42173Forfait horaire pour un médecin réaffecté à l’unité COVID-19, par période de 60 minutes complétées après un premier 4 heures d’activités211$

NOTICE ** For codes 42172 and 42173, enter the service start and finish time.

Billing code 42172 must only be used to bill the first 4 hours of one given day. The following hours must be billed with code 42173. No health card number is required.


4.2.2 Second reassigned physician:

In a COVID-19 unit, if at least seven beds in the unit are occupied by patients affected by COVID-19 or suspected of being, a second specialist can be reassigned between 8 a.m. and midnight to offer support to the intensivist who is in charge of the unit and to the first reassigned physician.

The second supporting physician is entitled to a lump-sum fee for a 4-hour activity period completed for which he or she is present in the COVID-19 intensive care unit.

For any participation of more than 4 hours, a fixed rate per hour can be applied for each complete 60-minute period.

CODESDESCRIPTIONRATE ($)
42174Forfait de 4 heures complétées pour un deuxième médecin réaffecté à l’unité COVID-19844$
42175Forfait horaire pour un deuxième médecin réaffecté à l’unité COVID-19, par période de 60 minutes complétées après un premier 4 heures d’activités211$

NOTICE ** For codes 42174 and 42175, enter the service start and finish time.

Billing code 42174 must only be used to bill the first 4 hours of one given day. The following hours must be billed with code 42175 . No health card number is required.


Limitations to the lump-sum fees for taking charge of a COVID-19 unit

A physician reassigned to a COVID-19 ICU can only take advantage of the terms provided for in this Lettre d'entente for activities performed in intensive care and cannot bill the lump-sum fees provided for in Lettre d'entente 238.

For any other reassignment period, on the same day, the physician may take advantage of the lump-sum fees provided for in Lettre d'entente 238, provided that it does not exceed a maximum of 12 hours for the two Lettres d'entente.

For the first reassigned physician, a maximum of 24 hours in total, per COVID-19 unit, and a maximum of 12 hours, per physician, per day are allowed.

For the second reassigned physician, a maximum of 16 hours in total, per COVID-19 unit, and a maximum of 12 hours, per physician, per day are allowed.

A physician who remains in a COVID-19 intensive care unit in a context of overflow or who is in support following a reassignment cannot receive other fees from the RAMQ for the services provided to any patient of the institution during the period in which he or she requests the lump-sum fees provided for in articles 5.1 to 5.3.

NOTICE ** Enter the service start and finish time for all the services carried out on the same day as a lump-sum for support to taking charge of the COVID-19 unit.

No on-duty surcharge provided for in Appendix 25 can be billed for COVID-19 intensive care units. A physician who has performed on a given day the activities provided for in Lettre d’entente 238 may not exceed a maximum of 12 hours per day for both Lettres d’entente.