Criteria:
All of the following criteria must be met:
- A special call for attendance is made on the patient’s behalf.
- The physician responds from outside the facility (hospital) on an unscheduled basis.
- There is direct physician attendance on a priority basis.
- The physician must claim based on the time the encounter commences and not the time of the call.
- Maximums that include callbacks both to in- and outpatients per physician apply:
- 03.03KA and 03.05N: Maximum five or any combination on any weekday (0700-1700 hours).
- 03.03LA and 03.05P: Maximum five or any combination on any weekday (1700-2200 hours).
- 03.03LA and 03.05R: Maximum 15 or any combination on any weekend day or stat holiday (0700-1700 hours).
- 03.03MC and 03.05QA: Maximum two or any combination any day (2200-2400 hours).
- 03.03MD and 03.05QB: Maximum seven or any combination any day (2400-0700 hours).
These fee codes may not be claimed for the following:
- Second and subsequent patients seen at the same callback. For second and subsequent patients seen at the same callback, use 03.03AR (if the criteria for 03.03AR are met).
- Encounters where the physician has initiated the service (i.e., scheduled it with the patient, asked the patient to return later in the day or returned to observe the patient.
- If the second encounter (the callback) is a continuation of a previous service (e.g., diagnostics ordered at the first encounter, results are ready, physician is called to review and provide treatment).
The second encounter may not be claimed as a callback, as it is a continuation of the first service.
Callbacks cannot be claimed in addition to psychiatric services, procedures, anesthetics or consultations.
Additional information:
- Callbacks should be claimed in addition to a visit:
- For inpatients, 03.03DF should be claimed in addition.
- For callbacks to LTC:
Review Callbacks to Long-term Care >>
- Callbacks can be claimed in addition to a visit when the purpose of the callback is to pronounce a patient’s death (G.R. 4.15). There is nothing billable for completing a death certificate. All criteria for a callback must still be met. Otherwise, only a visit item may be claimed for pronouncing the patient dead.
- You can claim the After-hours time premium (03.01AA) for the total time spent managing patient care when services are provided after hours in a regional facility:
Review After-hours Time Premium (03.01AA) >>
Access a chart that breaks down callbacks into their billable components:
Download the Callback to a Hospital Inpatient on a Priority Basis chart >>
Related fee codes:
Governing rules:
G.R. 15, 4.15