Criteria:
All of the following criteria must be met:
- Used when the care of a patient has been transferred to another physician who will continue to provide care for the patient.
- The physician receiving the care claims the transfer of care.
- Each physician may claim for services on the date of transfer if they have seen the patient.
- The TOC modifier is added to visit service claims (03.03D) by the receiving physician to indicate a transfer of care from one physician to another.
Adding the TOC modifier is only necessary if the transferring physician has claimed 03.03D on the same date of service as the receiving physician.
Fee codes for transfer of care:
Each of the following fee codes has specialty restrictions:
- 03.03AO may only be billed by CARD, CLIM, GNSG, E/M, HEM, INMD, MDON, NEPH, NPM, PDGE, PDNR, PED, PEDC, PEDN and RSMD.
- 03.03AU may only be claimed by ORTH, GNSG and UROL.
Fee code 03.03AI does not have a specialty restriction. However, this fee code may only be claimed in a functional centre ICU.
These fee codes may not be claimed for the following:
- Weekend coverage.
- May not be claimed within 24 hours of an admission, consultation or visit by the same physician on the same date of service.
Additional information:
- Transfer-of-care fee codes may only be claimed when there is direct attendance by the physician.
- The TOC modifier does not provide an additional fee — it only allows two physicians to claim 03.03D for the same patient on the same date of service.
- For transfer of care in the emergency department:
Related fee codes:
- 03.03AO Transfer of care of hospital inpatient:
- May only be claimed by endocrinology/metabolism, general internal medicine, general surgery, cardiology, hematology, clinical immunology, medical oncology, nephrology, pediatrics, pediatric subspecialties and respiratory medicine.
- May be claimed on the date of transfer by the receiving physician when assuming responsibility for care of a hospital inpatient.
- May only claim one transfer per patient, per calendar week, regardless of whether the same or different physician provides the service.
- The physician from whom the care is being transferred may claim a hospital visit or intensive-care visit on the day of transfer.
- May not be claimed for weekend coverage or within 24 hours of admission to hospital.
- May not be claimed in the post operative time period unless complications occur.
- 03.03AU Transfer of care of hospital in-patient or out-patient to operating physician:
- May only be claimed by orthopedics, general surgery and urology.
- May only be claimed when a consultation for the patient has already been claimed by another physician of the same specialty.
- May be claimed in addition to a procedure on the same date of service.
- 03.03AI Transfer of care of intensive-care patient:
- May be claimed on the date of transfer by the receiving physician when assuming responsibility for care of an intensive-care patient.
- Only one transfer may be claimed per patient, per calendar week, regardless of whether the same or different physician provides the service.
- The physician from whom the care is being transferred may claim a hospital visit or intensive-care visit, as appropriate, on the day of transfer.
- May not be claimed for weekend coverage or within 24 hours of admission to hospital.
- 03.05A may be claimed by the receiving physician after 30 minutes of time related to care of the patient has been spent.
Governing rules:
4.10