A claim for a home visit may be submitted for a service delivered anytime of the day. However, in order to submit a claim with a SUBD modifier, a special call for attendance must have been made by the patient or on behalf of the patient and the physician responded on an unscheduled basis within 24 hours of the call.
Private residence
If the physician visits the patient in their own private residence (free-standing home or apartment), claims may be submitted using 03.03N or 03.03P:
- 03.03N Home visit
- If there is only one person seen in the individual living quarter, claim 03.03N.
- Each individual living unit is considered a separate and distinct home. Each time a physician visits a patient in their living quarters 03.03N should be claimed.
- For an additional person seen in the same living quarters, see 03.03P.
- The location code should be HOME for this type of service.
- The CMGP modifier can be added to the claim as appropriate when the service is delivered by a GP.
- 03.03P (Home visit, second/subsequent patients)
- If there is more than one person living in the individual living unit, submit the claim for the second/subsequent patients seen in the unit using 03.03P.
- The location code should be HOME for this type of service.
- The CMGP modifier can be added to the claim as appropriate when the service is delivered by a GP.
DAL / AL, group home, seniors lodge or personal care home
If the physician visits the patient in their individual living quarters within a DAL / AL, group home, seniors lodge or personal care home, claims may be submitted using 03.03NA or 03.03NB:
- 03.03NA Home visit
- For the first patient seen at the complex/facility, 03.03NA would be billed.
- For an additional person seen in the same complex/facility in the same or different unit, see 03.03NB.
- The location code should be HOME for this type of service.
- The CMGP modifier can be added to the claim as appropriate when the service is delivered by a GP.
- 03.03NB (Home visit, second/subsequent patients)
- The second and subsequent patient seen in the same complex/facility in the same or different unit is to be billed using 03.03NB.
- The location code should be HOME for this type of service.
- The CMGP modifier can be added to the claim as appropriate when the service is delivered by a GP.
If the DAL / AL, group home, seniors lodge or personal care home provides space where a physician can see patients, claim an office visit (03.02A, 03.03A or 03.04A as appropriate to the service provided) with appropriate modifiers. The location code on these types of claims would be OTHR unless the facility has a registered office space with Alberta Health.
This fee code may not be claimed for the following
The SUBD modifier, indicates the time period in which a specific visit service took place. It is an additional payment that recognizes after-hours services. A SUBD modifier may only be claimed in addition to a home visit (03.03N, 03.03NA) when a request is made by the patient or on the patient's behalf and the physician responds within 24 hours of the call. If the physician initiates the service, claims for home visits MUST be submitted without the SUBD modifier.