- All consultations and visits for management and supervision of chronic dialysis
treatments regardless of frequency, type or location of service and includes chronic
dialysis of hospital inpatients.
- All consultations and visits within the scope of practice of nephrology and general
internal medicine for assessment and treatment of complications of chronic dialysis and
management of end stage renal disease and its complications in chronic dialysis patients.
- All related counselling, interviews, psychotherapy of patients and family members;
- All related case conferences.
The team fee does not include:
- Assessments and special visit premiums for emergent calls to the emergency department.
- Admission assessments and subsequent visits to acute care hospital in-patients for
treatment of complications of dialysis, chronic renal disease or intercurrent illness.
- Any other diagnostic and therapeutic procedures, including acute dialysis treatments.
- Consultations and assessments by specialists in other than internal medicine or internal
medicine sub-specialists other than nephrologists.
- Primary care by the patient’s family physician.
- Assessment by a renal transplantation specialist for entry into a transplantation
- Intermittent chronic hemodialysis treatment at an auxiliary treatment centre if fewer
than three dialysis treatments are rendered to the patient in the 7-day period referred to
||Chronic dialysis weekly team
fee - claim the code representing the predominant location and modality
||- hospital hemodialysis
||- hospital peritoneal dialysis
||- hospital self-care or satellite
||- independent health facility hemodialysis
||- home peritoneal dialysis
||- home hemodialysis
||Intermittent hemodialysis - at
an auxiliary treatment centre (per treatment, maximum 2 per patient per 7-day period
referred to above)
|Where 3 or more treatments are
rendered per 7-day period at an auxiliary treatment centre, the service comprises the
chronic dialysis weekly team fee paid at the full amount, regardless of the number of
I. Sleep Studies
Sleep studies services are redefined with technical component H and professional
components P1 and P2. The following is the text of the new section
within Diagnostic and Therapeutic Procedures:
The technical component H of the procedure is payable only for services provided in the
out-patient department of a hospital or in an off-site premise operated by the hospital
corporation that has received approval under section 4 of the Public Hospitals Act.
The specific elements for the technical component H include the specific elements for the
technical component of non-invasive diagnostic procedures listed in the Preamble to
Diagnostic and Therapeutic Procedures.
OTHER TERMS AND DEFINITIONS
- For the services rendered outside a hospital setting the only fees payable under the Health
Insurance Act are listed under the column P (use suffix C). Fees for the technical
component of these services are only payable under the Independent Health Facilities
- Fees for the technical component of services rendered in an Independent Health Facility
are listed in the Schedule of Facility Fees.
- For services provided for hospital out-patients, the total benefit is arrived at by
adding H plus P1 (first code listed,