Canada Telehealth & Remote Patient Monitoring Landscape

As we are remote patient monitoring company based out of Ottawa, Canada, this page is dedicated to building a robust nationwide telehealth & remote patient monitoring program in Canada. Aetonix operates in Canada, USA and UK. Out of these three countries, USA has been most progressive towards establishing telehealth or telemedicine as a part of mainstream healthcare culture. To achieve the quadruple aim of healthcare (improved clinical experience, improve patient experience, better outcomes and lower costs), technology via telehealth (which also includes remote patient monitoring) is simply unavoidable. Canada is making progress too, and we would like things to move faster, especially in light of a pandemic like COVID-19, where it is essential to be prepared with telehealth, even as a back up option. 

Over time, we will add more information to each province/category regarding their takes on all types of virtual care, but principally telehealth that includes video calls, store and forward image transfer, remote patient monitoring and virtual care coordination. Virtual or remote care is an ever evolving space, and by maintaining a countrywide page such as this, we will track the latest developments in each province/territory that makes it more conducive to practice telehealth. Canadian healthcare is great that it is universal, and is reasonably cost efficient, which is one of the quadruple aims of healthcare. But as far as patient experience and greater health outcomes go, there is much room for improvement. Such challenges can be addressed with telehealth. It is not a silver bullet, but a step toward the right direction of modernizing healthcare.

All provinces & territories have taken steps towards made telehealth more accessible during this time of public health emergency because of COVID 19. All except Quebec and Nunavut have enacted some some sort of temporary telehealth codes to facilitate payments for clinicians for providing virtual services. But all provinces and territories have encouraged physicians to use more of telehealth during this time, and all of have some sort of virtual resource page complete with a self assessment tool for COVID19. 

Select your province to find its telemedicine codes that have been made available to physicians to remotely treat patients at this time:
 

Alberta

Alberta Health is creating virtual Health Service Codes (HSCs) for the
following three services:

  1. Visit Services – HSCs: 03.03CV and 03.03FV
  2. Consultation Services – HSCs: 03.08CV and 08.19CX
  3. Mental Health Services – HSCs: 08.19CV and 08.19CW

 The following rules will apply to these new virtual HSCs:

  • The services provided under virtual care codes must be initiated by a
    patient or their agent and performed by a physician.
  • To be eligible for payment, the patient’s record must include a detailed
    summary of all services provided including the start and stop time.
  • Only time spent communicating with the patient can be claimed as part
    of the service. Time spent on administrative tasks cannot be claimed.
  • Each physician may only claim one of these virtual HSCs per patient in
    a single day.
  • No in person services can be claimed on the same day for the same
    patient if a virtual HSC is used.
  • Premiums, including age modifiers, complex modifiers, after hours
    time premium, Business Cost Program (BCP) and Rural Remote
    Northern Program (RRNP) will not apply to virtual HSCs.
  • Daily cap rules will not apply.
  • A service that does not meet the minimum requirements of these new
    virtual HSCs, or is less than 10 minutes must be claimed using HSC
    03.01AD.

Taken from the Alberta Government Bulletin for health professionals. Please follow their website for all the latest changes.

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British Columbia

The following codes below were always available, but new billing changes will allow

  • Telehealth fees to be used when the service is rendered over the telephone. This includes services for all patients including COVID-19 patients.
  • Telehealth fees to be claimed for consultations, office visits, and non-procedural interventions where there is currently no telehealth fee. These may be claimed under the “face to face” fee with a claim note record that the service was provided via video technology or telephone and is payable by MSP.

IN ADDITION, THERE ARE TWO NEW FEE ITEMS RELATING TO COVID-19 FOR BC PHYSICIANS
The following new fee items have been approved on a temporary basis. The cancellation date will be determined by the Provincial Health Officer. These fee items are billable in addition to a Telehealth (video or telephone) service on the same day.
MSP & WSBC Fee ($)

T13701 Office Visit for COVID-19 with test………………………………………………………………………………………50.00
NOTES:
i) Payable for patients with suspected or active COVID19 symptoms only.
ii) COVID-19 testing must be performed.
iii) Not intended for providing general information on a viral infection, including COVID-19.
iv) Not payable in addition to any other office visits to the same physician for same patient, same day.

T13702 Office Visit for COVID-19 without test……………………………………………………………………………… 40.00
NOTES:
i) Payable for patients with suspected or active COVID-19 symptoms.
ii) Not intended for providing general information on a viral infection, including COVID-19.
iii) Not payable in addition to any other office visits to the same patient, same day.
For more information, e-mail: economics@doctorsofbc.ca

This information was taken fromDoctors of BC. Please follow theirwebsite for all the latest changes.

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Manitoba

New “virtual visit” tariffs have been developed and approved by Manitoba Health and Doctors Manitoba.
• Virtual visit tariffs apply to patient assessments conducted via phone and video.
• These new tariffs apply to all fee-for-service physicians.

 8321 Virtual Visit by telephone or video

Rate: Paid equal to the regional history and examination rate for the physician’s bloc of practice, or subsequent visit rate if no regional visit is listed.

A virtual visit by telephone or video is a service provided to a patient which shall
be comprised of:
• A history of the presenting complaint(s);
• An assessment of the parts or systems related to the presenting complaint(s);
• A review of pertinent investigations;
• A complete written record and advice to the patient.

All physician blocks can use tariff 8321 for virtual visits, paid equal to the regional history and examination rate or subsequent visit
rate for the physician’s block of practice.

8533 Virtual psychotherapy by telephone or video

Rate: $49.40

o Psychiatrists can use tariff 8533 for virtual psychotherapy, paid at the same rate as in-person psychotherapy.
• Virtual care tariffs are effective March 14, 2020 and apply during the COVID-19 pandemic situation only. Doctors Manitoba will inform you as soon as Manitoba Health communicates that these virtual visit tariffs are no longer available.
• The new tariffs may should be active in the claims processing system by March 20, 2020; maintain your records in anticipation of the tariffs being available.

 

Taken from Doctors Manitoba. Follow their website for all the latest changes.

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New Brunswick

From March 13th, physicians are permitted to bill the consultation and repeat consultation codes for their specialty as they would normally would during a face to face encounter. Physicians must include location “0” on their claim submission. No add-ons or premiums can be billed in addition. Taken from the New Brunswick Department of Health.

These telemedicine Codes had always existed.

8717 Attendance – 1st patient seen, first 15 minutes……………………………………………………………………………..$40
8781 Add – per 15 minutes………………………………………………………………………………………………………………………….$20
Medicare Note: Payable for the first patient seen in a telemedicine session, payable once
per day by same or different patient. Referral number of remote specialist is required.

8719   Technical Standby, per ¼ hour ……………………………………………………………………………………………………..$20
Medicare Note: Service Code 8719 is an all-inclusive fees that cover a maximum of 30
minutes per patient. No other service can be billed during this time. Only applies if the
telemedicine service is delayed or interrupted for technical reasons. Referral number of
remote specialist is required.

8119 Telemedicine follow-up (use the generic value of $1.01) ………………………………………………………………$50
Medicare Note: Service code 8119 is open to Location 8 only and is to be used instead of
the service code for scheduled OPD clinics when providing a follow-up Telemedicine
service as outlined in the Physicians’ Manual in Chapter 4, Section 2.15.13. Service Code
8119 is not billable with Service Codes 8717 and 8718 (same physician or Service Codes
8898 or 8899).

Taken from New Brunswick Physician’s Manual.

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Newfoundland and Labrador

Arrangements Reached on Fee-for-service Virtual Care during Pandemic Period
The NLMA has reached an agreement with the Department of Health and Community Services on
compensation for fee-for-service virtual care services during the pandemic period. The specific
arrangements can be summarized as follows:

  1. Covers both telephone and video-conference patient interactions. The location of the
    provider and patient must be in the province.
  2. Retroactive to include services starting on March 18, 2020 as long as billing requirements
    are met.
  3. Fee – $42 per visit, no add-ons or premiums.
  4. Physicians are recommended to use the Cisco Jabber application for virtual care available
    through NLCHI, though physicians using any other video-conferencing platform can still bill
    this code.
  5. One visit per patient, per physician, per day can be billed, though additional medically
    necessary visits per patient on the same day can be claimed IC.
  6. The fee is not billable by physicians who are compensated by salary, independent contracts,
    APPs or sessional arrangements.
  7. There is a daily limit of 40 units of virtual care (see below).
  8. Record Requirements
    a. documentation must meet the minimum requirements for a visit as stated in the MCP
    Medical Payment Schedule preamble section 4.2.2., with the exception of physical
    examination documentation.
    b. the record of service must include the patient’s telephone number if contact is made
    by phone.
    c. the record of service must contain the start and stop times of the patient encounter.
    d. patient consent for a Virtual Care Assessment must be obtained and documented on
    the medical record.
  9. This service cannot be delegated by the physician. It must be direct physician to patient
    contact in real time.
  10. This fee is not payable for prescription renewals, notification of normal test results, or
    notification of office, referral or other appointments or other administrative tasks.

Taken from Newfoundland and Labrador Medical Association.

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Northwest Territories

NWT Locum Hiring during COVID-19 

In anticipation of the increased burden on the Northwest Territories Health and Social Services System (HSS System) as a result of the COVID-19 pandemic, the Northwest Territories is actively looking for both locum and permanent health and social services professionals ready and willing to work in the Northwest Territories. Our current locum and permanent needs include Physicians and Registered Nurses.

Taken from PracticeNWT.

Telehealth Codes

Taken from Insured Services Tariff.

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Nova Scotia

COVID-19 Telemedicine Services

The College recognizes the growing role of telemedicine or virtual medicine in our pandemic response. As such, the College wishes physicians to be aware of the following:

  1. For physicians licensed in Nova Scotia, there is no requirement for College approval for this field of practice.
  2. Any physician licensed in Canada may deliver telemedicine services in Nova Scotia, unless specifically restricted from doing so by their licensing body;
  3. The regulation of the medical services you provide into Nova Scotia rests with your licensing college.
  4. All physicians delivering telemedicine services in Nova Scotia should refer to the College’s Professional Standards for the Provision of Telemedicine Services.

Taken from College of Physicians & Surgeons of Nova Scotia

 Telemedicine Codes

 

Taken from Doctors Nova Scotia.

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Nunavut

Telehealth billing codes are not available.

Department of Health Services says

Access to health care services will remain available in all communities seven days a week. All non-urgent requests will be triaged daily. Immediate access to urgent and emergent health care services are and will continue to be available 24 hours a day, seven days a week. All clients are asked to call before presenting at a health facility.

  • In Iqaluit, public health, the emergency room and inpatient unit will remain open.
  • Well baby clinics, prenatal visits and immunizations are continuing across Nunavut.
  • Physicians will continue community visits. If this is not possible, the visits will be conducted by telehealth or by phone.
  • Options are being pursued for additional crisis debriefing and counselling support via telephone and telehealth.

Taken from Nunvavut Department of Health Services.

When can Nunavut Telehealth be used?

Nunavut Telehealth supports both clinical and non-clinical sessions. Please refer to the telehealth request forms.

Clinical Session: Consultations/assessments, referral, case conferencing, follow-ups/post-operative care, debriefing and counselling services.

Non-Clinical Session: Long term & home care family visits, patient/client education, professional training/continuing education, and administrative meeting.

 How is a Nunavut Telehealth appointment initiated?

Health-care providers/scheduling assistants are to complete Telehealth request forms.

Nunavut:

Please submit a completed Nunavut Telehealth request form and email to GN.Telehealth@gov.nu.ca

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Ontario

Temporary Codes

K080:

Minor assessment of a patient by telephone or video, or advice or information by
telephone or video to a patient’s representative regarding health maintenance,
diagnosis, treatment and/or prognosis – $23.75

K081:

  1. intermediate assessment of a patient by telephone or video, or advice or
    information by telephone or video to a patient’s representative regarding
    health maintenance, diagnosis, treatment and/or prognosis, if the service lasts a minimum of 10 minutes; or
  2. psychotherapy, psychiatric or primary mental health care, counselling or interview conducted by telephone or video, if the service lasts a minimum of 10 minutes – $36.85

K082:

Psychotherapy, psychiatric or primary mental health care, counselling or
interview conducted by telephone or video per unit (unit means half hour or
major part thereof) per unit – $67.75

K083:

Specialist consultation or visit by telephone or video payable in increments of – $5.00

Taken from Ontario Ministry of Health’s website.

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Prince Edward Island

VIRTUAL CODES

Effective March 16, 2020, physicians are eligible to bill for following fee codes for services delivered via virtual
care (telephone, secure videoconferencing, and secure email/text) during the COVID-19 pandemic:

  • xx13: Limited Office Visit
  • 2505: Health Promotion Counseling
  • 2501/2504: Psychotherapy
  • 2588/2586/2886: Diagnostic and Therapeutic Interview
  • xx60: Consultation
  • xx62: Repeat consultation
  • 2863: Geriatric follow up visit
  • 0705: Postnatal visit
  • xx10: specialist comprehensive office visit

Taken from Health PEI’s memorandum

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Quebec

Telehealth billing codes are not available. 

But, family physicians and general practitioners advised to provide telemedicine or virtual care when possible

Regular follow-ups, which do not necessarily require a physical examination, can therefore, for a certain period of time, be carried out without a physical visit. Examples include follow-up visits, minor ad hoc follow-ups, complex follow-ups, clinical intervention, psychotherapy and even standard pregnancy follow-ups. It is up to the doctor to decide, on a case-by-case basis, whether a physical examination is necessary or whether it can be done without the patient needing to be seen.

Regarding the conditions of remuneration, they will be exactly the same as those currently provided in our nomenclatures: same act, same price. There will therefore be no new “code” proper, since we are talking about the same medical procedure which investigates the same expertise and the same responsibility but whose performance is just modified as to form.

Taken from Federation of Medical Specialists of Quebec.

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Saskatchewan

Virtual assessment

Working with the Ministry of Health, the SMA has secured a temporary payment for Pandemic Telephone Assessment (510A) for direct patient care provided by physicians over the telephone and Pandemic Video Assessment (515A) for care provided via video conferencing. This initiative enables greater access for patients and provides for a safer workplace for staff and physicians in primary health care clinics.

510A Pandemic Telephone Assessment ($35.00):
View Billing Information sheet.

Highlights:

  • Physicians who are compensated by an alternate payment plan (APP), or directly by the Saskatchewan Health Authority (SHA) are permitted to “shadow bill” these services.
  • Physicians can be paid for telephone assessments not restricted to diagnosis specific to COVID-19.
  • Telephone assessment cannot be billed with any additional service codes.
  • Services provided in person may be billed according to the Payment Schedule.
  • A maximum of two telephone assessments per patient per day by any physician.
  • Physicians are responsible to ensure proper documentation of the telephone assessment.

This temporary code is now available in the MedAccess and Accuro EMRs.

515A Pandemic Video Assessment ($35.00)
View Billing Information sheet

The SMA, in collaboration with the Ministry of Health, has made progress on facilitating the patient video assessment. A software called PEXIP (https://www.pexip.com ) has been previously evaluated and assessed. This software has been selected to deploy in physician clinics to support your immediate need for patient video assessments. The billing fee code for video assessment is 515A.

Taken from the Saskatchewan Medical Association

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Yukon

Yukon Telemedicine Pay Schedule

Heading Sub Heading Code Title Amount Anaes Or
Proc Code
TELEMEDICINE 2600 Telemedicine Transmission or Review: For any condition(s) requiring partial or regional examination and history (2600 to be billed when sending or replying to a telemedicine transmission). $47.30
    2601 Detailed Telemedicine Transmission or Review and Reply: For any condition requiring a complete review of examination and detailed history. NOTE: A complete review of examination shall include complaints, history of the present and past illness, pertinent family history, functional inquiry, differential diagnosis, and provisional diagnosis. A minimum of 20 minutes of the physicians time should be spent for review and reply of transmission. $94.50
    2602 Telemedicine Consultation: To include review of history, review applicable x-rays and laboratory findings and a written report. A minimum of 30 minutes of the physicians time should be spent for review and reply of transmission. $153.10
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