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

Update 2020-09-01

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.

Seven 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.
  • Patient with severe loss of autonomy -> 15781,15782, 15783 and 15784 are billable
  • 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
  • Codes 15900, 15901, 15905, 15906 and 15907 are billable if equivalent to a follow-up visit
  • 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 in contact with a suspected or confirmed Covid-19 patient
  • OR
  • Emergency Clinic /RI/RPA/CHSLD in a socio-sanitary region identified as a hot zone (Montréal, Laval, Lanaudière et Montérégie)
  • LE 269 designated facility/unit
  • Billable during operation hours of the CDÉ/Unit
  • Not billable for remote visits
  • Emergency Room outside of a socio-sanitary 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.
    • 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 Service rendu dans le cadre du programme de soutien à domicile en CLSC
    • Bill code:minutes:beginning time-end time ( )
    Services SATURDAY between 08:00 et 16:00 designated facility 0XXX7
    • Sector = ER
    • Beginning timeline 1 = 16:00 / Code = 19680:240:1600-2000
  • 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/CDD -> (On week-ends and public holidays) Can be billed from 08:00 to 24:00
    • A doctor practicing in the emergency room can claim his usual on-call supplements (SS or SSDF) when the 19683 package is unavailable.
    • Use one line-> code:minutes:beginning time-endtime ()
    Services rendered on SATURDAY BETWEEN 16:00 and 24:00 designated facility 0XXX7
    • Sector = ER
    • Beginning timeline 1 = 16:00/Code = 19680:480:1600-2000
    • Beginning timeline 2 = 20:00/Code = 19680:480:2000-2400
    • Beginning timeline 3 = 18:00/Code = 19683:360:1800-2400
    • Beginning timeline 4 = 16:00/Code = SSDF:120:1600-1800
  • 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 #CDEService rendu en clinique d’évaluation ()
    Services rendred between 16h(4pm) et 24h(midnight), ON A HOLIDAY, in a CDE facility when the physician would normally be working at his office :
    • Sector/Facility = Extern clinic
    • Beginning timeline 1 = 16:00 / Code = 19680:240:1600-2000
    • Beginning timeline 2 = 16:00 / Code = 19680:240:1600-2000#CDE
    • Beginning timeline 3 = 20:00 / Code = 19680:240:2000-2400
    • Beginning timeline 4 = 20:00 / Code = 19681:240:2000-2400#CDE
    • Beginning timeline 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
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 ($186.15 / hour)
      • Bill code: minutes:start time-end time
      • Add context #SRVPService rendu en sans rendez-vous populationnel
    • Package for office fees/expenses -> Codes 19928 or 19929 if normally entitled, depending on the number of patients seen
    • Unfavorable GMF-R hours -> Code 19893 between 18:00 and 22:00 on weekdays/Code 19894 between 08:00 and 22:00 Federal and public holidays ()
    Service SUNDAY between 08:00 and 16:00 GMF-R 5XXXX establishment designated SRVP :
    • Start time - line 1 = 8:00/Code = 19680:480: 0800-1600#SRVP
    • Start time - line 2 = 8:00/Code = 19929 (+20 pts. seen)
    • Start time - line 3 = 8:00/Code = 19894:480:0800-1600
  • In GMF-U or GMF (CLSC) establishment:
    • Choice at an hourly rate, per full hour:
      • Mixed mode or live mode -> Code 42183 ($ 143 / hour)
      • Fixed fee mode combined mixed -> Code 42184 ($ 37.80 / hour)
      • Bill code: minutes:start time-end time
      • Add context #SRVP Service rendered without a population meeting ()
      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
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 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
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
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 code 103324
  • 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
    • 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 >

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 CDEService rendu en clinique d’évaluation (CDÉ)
New SRVPService rendu en sans rendez-vous populationnel
New SD19Service rendu dans le cadre du programme de soutien à domicile en CLSC

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.
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
  • Billing Code 15618 -> To be billed in the designated RI/RPA, or as part of the home support program.
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

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 »