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PCCM In-Basket Fee Codes

Physicians and teams can review Health Service Codes (HSC) and descriptions for the Physician Comprehensive Care Model (PCCM). 

The PCCM uses existing fee-for-service (FFS) Health Service Codes (HSC). Approximately 94% of HSCs used by community Family Medicine are included under the PCCM and these HSCs are referred to as “in-basket.”

In-basket HSCs are paid at 68.5% of the FFS value and complexity modifiers CMGP and CMXC30 are not paid under the PCCM. The proration does not apply to the tray fees which are paid according to the Alberta Schedule of Medical Benefits (SOMB) rules.

Any HSCs not defined in the list of in-basket codes is considered out-of-basket and paid at 100% of the FFS amount. Remember, the time-based payments and complexity-adjusted panel payments apply under the PCCM.

Questions or feedback? Physicians and teams can utilize our PCCM General Inquiry Form.

PCCM In-Basket Service Codes

Visit HSCs   

Description 

03.01AD 

Diagnostic interview and evaluation, unqualified {Advice to a patient or their agent (agent as defined in the Personal Directives Act) via telephone, secure email or videoconference} 

03.01B 

Diagnostic interview and evaluation, unqualified {Patient care advice provided to community mental health care workers, child protection workers, group home staff, or educational personnel weekdays 0700 to 1700 hours in relation to the care and treatment of a patient receiving community mental health care services under the Alberta community mental health care program.} 

03.01BA 

Diagnostic interview and evaluation, unqualified {Patient care advice provided to community mental health care workers, child protection workers, group home staff, or educational personnel weekdays 1700 to 2200 hours, weekends and statutory holidays 0700 to 2200 hours in relation to the care and treatment of a patient receiving community mental health care services under the Alberta community mental health care program.} 

03.01BB 

Diagnostic interview and evaluation, unqualified {Patient care advice provided to community mental health care workers, child protection workers, group home staff, or educational personnel any day 2200 to 0700 hours in relation to the care and treatment of a patient receiving community mental health care services under the Alberta community mental health care program.} 

03.01C 

Diagnostic interview and evaluation, unqualified {Telehealth assistance service} 

03.01CC 

Telephone advice and counselling to a patient or their agent (agent as defined in the Personal Directives Act) regarding the COVID-19 vaccine 

03.01LG 

Diagnostic interview and evaluation, unqualified {Physician to physician or podiatric surgeon telephone or telehealth videoconference or secure videoconference consultation, referring physician, weekdays 0700 to 1700 hours} 

03.01LH 

Diagnostic interview and evaluation, unqualified {Physician to physician or podiatric surgeon telephone or telehealth videoconference or secure videoconference consultation, referring physician, weekdays 1700 to 2200 hours, weekends and statutory holidays 0700 to 2200 hours} 

03.01LI 

Diagnostic interview and evaluation, unqualified {Physician to physician or podiatric surgeon telephone or telehealth videoconference or secure videoconference consultation, referring physician, any day 2200 to 0700 hours} 

03.01LJ 

Diagnostic interview and evaluation, unqualified {Physician, nurse practitioner, midwife or podiatric surgeon to physician telephone or telehealth videoconference or secure videoconference consultation, consultant, weekdays 0700 to 1700 hours} 

03.01LK 

Diagnostic interview and evaluation, unqualified {Physician, nurse practitioner, midwife or podiatric surgeon to physician telephone or telehealth videoconference or secure videoconference consultation, consultant, weekdays 1700 to 2200 hours, weekends and statutory holidays 0700 to 2200 hours} 

03.01LL 

Diagnostic interview and evaluation, unqualified {Physician, nurse practitioner, midwife or podiatric surgeon to physician telephone or telehealth videoconference or secure videoconference consultation, consultant, any day 2200 to 0700 hours} 

03.01N 

Diagnostic interview and evaluation, unqualified {Management of anticoagulant therapy to include ordering necessary blood tests, interpreting results, adjusting the anticoagulant dosage as required} 

03.01NG 

Diagnostic interview and evaluation, unqualified {Patient care advice to paramedic - pre hospital patch, Mobile Integrated Healthcare Unit paramedic, assisted living/designated assisted living and lodge staff, active treatment facility worker for hospital in-patient, long term care worker for patients in a long term care facility, nurse practitioner, hospice worker, home care worker, midwife or public health nurse weekdays 0700 to 1700 hours, provided via telephone or other telecommunication methods, in relation to the care and treatment of a patient} 

03.01NH 

Diagnostic interview and evaluation, unqualified {Patient care advice to paramedic - pre hospital patch, Mobile Integrated Healthcare Unit paramedic, assisted living/designated assisted living and lodge staff, active treatment facility worker for hospital in-patient, long term care worker for patients in a long term care facility, nurse practitioner, hospice worker, home care worker, midwife or public health nurse weekdays 1700 to 2200 hours, weekends and statutory holidays, 0700 to 2200 hours, provided via telephone or other telecommunication methods, in relation to the care and treatment of a patient} 

03.01NI 

Diagnostic interview and evaluation, unqualified {Patient care advice to paramedic - pre hospital patch, Mobile Integrated Healthcare Unit paramedic, assisted living/designated assisted living and lodge staff, active treatment facility worker for hospital in-patient, long term care worker for patients in a long term care facility, nurse practitioner, hospice worker, home care worker, midwife or public health nurse any day 2200 to 0700 hours, provided via telephone or other telecommunication methods, in relation to the care and treatment of a patient} 

03.01NM 

Diagnostic interview and evaluation, unqualified {Patient care advice to a pharmacist provided via telephone or other telecommunication methods in relation to the care and treatment of a patient} 

03.01O 

Diagnostic interview and evaluation, unqualified {Physician or Nurse Practitioner to Physician secure E-Consultation, consultant} 

03.01R 

Diagnostic interview and evaluation, unqualified {Physician to Physician secure E-Consultation, referring physician} 

03.01S 

Diagnostic interview and evaluation, unqualified {Physician to patient secure electronic communication} 

03.01T 

Diagnostic interview and evaluation, unqualified {Physician to patient secure videoconference} 

03.02A 

Diagnostic interview and evaluation, described as brief {Brief assessment of a patient's condition requiring a minimal history with little or no physical examination} 

03.03A 

Diagnostic interview and evaluation, described as limited {Limited assessment of a patient's condition requiring a history related to the presenting problems, an examination of the relevant body systems, appropriate records, and advice to the patient - in office.} 

03.03B 

Diagnostic interview and evaluation, described as limited {Prenatal visit - in office.} 

03.03C 

Diagnostic interview and evaluation, described as limited {Routine post-natal office examination} 

03.03CV 

Diagnostic interview and evaluation, described as limited {Assessment of a patient's condition via telephone or secure videoconference.} 

03.03N 

Diagnostic interview and evaluation, described as limited {Home visit - first patient} <<Home Visits>> 

03.03P 

Diagnostic interview and evaluation, described as limited {Home visit - second/subsequent patients} 

03.04A 

Diagnostic interview and evaluation, described as comprehensive {Comprehensive assessment of a patient's condition requiring a complete history, a complete physical examination appropriate to the physician's specialty, an appropriate record and advice to the patient - in office.} 

03.04B 

Diagnostic interview and evaluation, described as comprehensive {Initial prenatal visit requiring complete history and physical examination} 

03.04I 

Diagnostic interview and evaluation, described as comprehensive {Comprehensive visit, including completion of form, required for admission to a regional health authority addiction residential treatment centre} 

03.04K 

Diagnostic interview and evaluation, described as comprehensive {Comprehensive geriatric assessment, first full 90 minutes} 

03.04M 

Diagnostic interview and evaluation, described as comprehensive {Pre-operative history and physical examination in relation to an insured service} 

03.04N 

Diagnostic interview and evaluation, described as comprehensive {Comprehensive evaluation including completion of forms to determine capacity as defined by the Personal Directives Act (PDA) (RSA 2007 s9(2)(a))} 

03.04Q 

Diagnostic interview and evaluation, described as comprehensive {Post surgical cancer surveillance examination} 

03.05I 

Other diagnostic interview and evaluation {Direct care, reassessment, education and/or general counselling of a patient requiring palliative care, per 15 minutes or portion thereof - in office or a patient's home} 

03.05JA 

Other diagnostic interview and evaluation {Formal, scheduled, multiple health discipline team conference, full 15 minutes or major portion thereof for the first call when only one call is claimed} <With para-medical personnel regarding the provision of health care where social and other issues are involved> 

03.05JB 

Other diagnostic interview and evaluation {Formal, scheduled family conference relating to a specific patient, per 15 minutes or major portion thereof} 

03.05JH 

Other diagnostic interview and evaluation {Family conference via telephone, in regards to a community patient} 

03.05JN 

Other diagnostic interview and evaluation {Second and subsequent physician attendance at a formal, scheduled, professional conference related to the care and treatment of multiple patients undergoing rehabilitation therapy including those with chronic pain, when discussion occurs on behalf of a specific patient per full 5 minutes to a maximum of 6 units in a 30 minute period} 

03.05JQ 

Other diagnostic interview and evaluation {Family conference with relative(s) via telephone in connection with the management of a patient with a psychiatric disorder} 

03.05JR 

Other diagnostic interview and evaluation {Physician telephone call directly to patient, to discuss patient management/diagnostic test results} 

03.05LA 

Other diagnostic interview and evaluation {Group session, multiple patients, where a physician is involved in providing care and teaching to patients in attendance} 

03.05O 

Other diagnostic interview and evaluation {Direct management, reassessment, education and/or general counselling of a patient with chronic pain, per 15 minutes or portion thereof} 

03.05T 

Other diagnostic interview and evaluation {Formal, scheduled, professional interview relating to the care and treatment of a palliative care patient with other physicians, family, and/or direct therapeutic supervision of allied health professionals or community agencies, on behalf of a specific patient, full 15 minutes or major portion thereof for the first call when only one call is claimed} 

03.05U 

Other diagnostic interview and evaluation {Second and subsequent physician attendance at formal, scheduled, professional interview relating to the care and treatment of a palliative care patient with other physicians, family and/or direct therapeutic supervision of allied health professionals or community agencies, on behalf of a specific patient, full 15 minutes or major portion thereof for the first call when only one call is claimed} 

03.05V 

Other diagnostic interview and evaluation {Formal, scheduled, professional interview relating to the care and treatment of a patient with chronic pain with other physicians, and/or direct therapeutic supervision of allied health professionals or community agencies, on behalf of a specific patient, per 15 minutes} 

03.05X 

Other diagnostic interview and evaluation {Formal, scheduled, professional interview with relative(s) relating to the care and treatment of a patient with chronic pain on behalf of a specific patient, full 15 minutes or major portion thereof for the first call when only one call is claimed} 

03.07A 

Consultation, described as limited {Minor consultation - in office} 

03.07B 

Consultation, described as limited {Repeat consultation} 

03.08A 

Consultation, described as comprehensive {Comprehensive consultation - in office} 

03.08CV 

Consultation, described as comprehensive {Comprehensive consultation via telephone or secure videoconference} 

03.08F 

Consultation, described as comprehensive {Formal, comprehensive consultation, for a patient with chronic pain, full 60 minutes or major portion thereof for the first call when only one call is claimed} 

07.57B 

Application of other wound dressing {Subsequent treatment - minor burns - dressing and/or debridement} 

08.19CW 

Other psychiatric evaluation and interview {Telephone or secure videoconference with a patient for scheduled psychiatric treatment or for a palliative care or a chronic pain visit by an eligible physician, per 15 minutes or major portion thereof.} 

08.19D 

Other psychiatric evaluation and interview {Professional interview with relative(s) in connection with the management of a patient with a psychiatric disorder, but without the patient being present during the interview, per 15 minutes or major portion thereof} 

08.19F 

Other psychiatric evaluation and interview {Formal, scheduled, professional conference related to the care and treatment of a psychiatric patient with other physician(s), and/or direct therapeutic supervision of, allied health professionals, educational, correctional and other community agencies on behalf of a specific patient, provided by the physician most responsible for the patient's care, per 15 minutes or major portion thereof} 

08.19G 

Other psychiatric evaluation and interview {Direct contact with an individual patient for psychiatric treatment (including medical psychotherapy and medication prescription), psychiatric reassessment, patient education and/or general psychiatric counselling, per 15 minutes or major portion thereof - in office.} 

08.19H 

Other psychiatric evaluation and interview {Second and subsequent physician attendance at a formal, scheduled, professional conference related to the care and treatment of a psychiatric patient, on behalf of a specific patient, per 15 minutes or major portion thereof} 

08.19J 

Other psychiatric evaluation and interview {Formal, scheduled, professional conference related to the care and treatment of multiple psychiatric patients with other physician(s), allied health professionals, educational, correctional and other community agencies on behalf of a specific patient, provided by the physician most responsible for the patient's care} 

08.19K 

Other psychiatric evaluation and interview {Second and subsequent physician attendance at a formal, scheduled, professional conference related to the care and treatment of multiple psychiatric patients, when discussion occurs on behalf of a specific patient} 

08.44A 

Group therapy {Group psychotherapy, where all members of the group are receiving therapy in the session, full 15 minutes or major portion thereof for the first call when only one call is claimed} 

08.45 

Family therapy {Assessment or therapy of a family, requiring comprehensive psychiatric or family systems evaluation, first full 45 minutes or major portion thereof for the first call when only one call is claimed - in office.} 

13.59V 

Immunization and administration of COVID-19 vaccine 

13.59VA 

Prolonged COVID-19 vaccination - physician time only, greater than 10 minutes 

13.82A 

Ultraviolet light therapy {Psoralen ultraviolet A treatment, ultraviolet B or narrow-band ultraviolet B treatment} 

13.99J 

Other diagnostic interview and evaluation {Medical emergency detention time, per 15 minutes} 

98.12S 

Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Non surgical treatment, cryotherapy} <<Condylomata acuminata>> 

 

PCCM In-Basket Procedure Codes

Procedure HSCs    

Description   

03.12A   

Measurements and manual examination of nervous system and sense organs {Intraocular pressure measurement, unilateral or bilateral}   

07.57A   

Application of other wound dressing {Initial treatment - minor burn}   

10.16B   

Insertion of other vaginal pessary {Pessary removal, adjustment and/or reinsertion}   

11.71A   

Removal of intrauterine contraceptive device (IUD) {Removal of intrauterine contraceptive device (IUD)}   

12.21   

Removal of intraluminal foreign body from ear without incision   

13.42A   

Immunization for allergy {Desensitization treatments with allergy serums}   

13.53B   

Injection of steroid {Intralesional injection(s) of steroid}   

13.59A   

Injection or infusion of other therapeutic or prophylactic substance nec {Intramuscular or subcutaneous injections}   

13.59J   

Injection or infusion of therapeutic or prophylactic substance NEC {Injection with local anesthetic of myofascial trigger points}   

13.59O   

Injection or infusion of therapeutic or prophylactic substance NEC {Injections of Botulinum A Toxin for the prophylaxis of chronic migraine headaches for eligible patients 18-65 years of age}   

13.99BA   

Other miscellaneous diagnostic and therapeutic procedures NEC {Periodic Papanicolaou Smear for patients between the ages of 21 and 69}   

13.99BE   

Other miscellaneous diagnostic and therapeutic procedures NEC {Pelvic examination using a speculum requiring swab(s) and/or sample(s) collection}   

17.71A   

Peripheral nerve injection, unqualified {Local block(s) of somatic nerve(s)}   

37.91A   

Lingual frenotomy {Release of simple tongue tie, clipping}   

51.92A   

Injection of sclerosing agent or solution into vein {Varicose vein, single injection}   

51.92B   

Injection of sclerosing agent or solution into vein {Varicose vein, additional injection}   

80.83B   

Uterine biopsy {Endometrial biopsy}   

81.8   

Insertion of intra-uterine contraceptive device   

93.91A   

Arthrocentesis {Joint aspiration, injection, hip}   

93.91B   

Arthrocentesis {Joint aspiration, injection, other joints}   

95.93   

Injection/aspiration of therapeutic substance into bursa <Subacromial>   

95.94A   

Injection of therapeutic substance into other soft tissue {Injection with local anesthetic of myofascial trigger points combined with a spray and stretch technique}   

95.96A   

Aspiration of other soft tissue {Other bursae, tendon sheaths, ganglion of wrist or ankle, aspiration, injection}   

98.01A   

Tattooing or insertion into skin and subcutaneous tissue {Implantation of subdermal contraceptive implant}   

98.03A   

Other incision with drainage of skin and subcutaneous tissue {Incision and drainage of abscess or hematoma, subcutaneous or submucous}   

98.04B   

Incision with removal of foreign body of skin and subcutaneous tissue {Incision with removal of foreign body of skin and subcutaneous tissue without anesthesia}   

98.11A   

Debridement of wound or infected tissue {Non-functional area, up to 32 total square cms}   

98.11D   

Debridement of wound or infected tissue {Functional area, up to 32 total square cms}   

98.12A   

Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Excisional biopsy, skin}   

98.12B   

Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Excisional biopsy, skin of face}   

98.12C   

Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal of sebaceous cyst}   

98.12H   

Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Excision of soft tissue tumor(s) (subcutaneous) full 30 minutes of operating time or major portion thereof for the first call when only one call is claimed}   

98.12J   

Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal or excision, first lesion}   

98.12K   

Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal by fulguration, first lesion}   

98.12L   

Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Non-surgical treatment (cryotherapy, chemotherapy), warts or keratoses}   

98.12M   

Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal of pigmented benign nevus, excluding face}   

98.12N   

Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal of pigmented benign nevus of the face}   

98.12Q   

Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal of any atypical or neoplastic lesion(s) - any method excluding cryotherapy for actinic keratoses} <<Multiple dysplastic or localized carcinomatous lesions of the skin>>   

98.12R   

Local excision or destruction of lesion or tissue of skin and subcutaneous tissue {Removal of first plantar wart}   

98.22A   

Suture of skin and subcutaneous tissue of other sites {Laceration, face, up to 2.5 cms (1 unit) or body, up to 5 cms (1 unit)}   

98.22B   

Suture of skin and subcutaneous tissue of other sites {Laceration, face, over 2.5 cms (1 unit) and/or body, over 5 cms (1 unit)} <For each layer or unit, refer to Price List>   

98.81A   

Biopsy of skin and subcutaneous tissue {Biopsy, skin}   

98.81B   

Biopsy of skin and subcutaneous tissue {Punch biopsy}   

98.96A   

Removal of nail, nailbed or nailfold {Wedge excision}   

98.99AA   

Other operations on skin and subcutaneous tissue NEC {Acne surgery}<For incision and drainage and/or cryotherapy of cysts; and superficial peels for acne including liquid nitrogen and glycolic peels>