After-hours premium or extended hours premium: which applies in Manitoba?

Fee box

When it applies / when it does not

The manual gives the hours in 24-hour time. Here they are side by side, by the time the service starts.

On a designated holiday, the daytime and evening hours follow the last row (A-125, A-126, B-1). On weekdays that are not holidays, no after-hours premium covers 7:01 a.m. to 4:59 p.m. (B-1). The manual lists the 13 designated holidays on pages A-126 and B-2.

Where both columns cover the same time, you can claim one premium on a service, not both (A-126). For an urgent visit in your clinic's own advertised hours, the manual does not say which one. See the drop-in clinic point below, and ask Manitoba Health before you bill 5555 or 5550.

After-hours premium: when it applies

• "After Hours Premiums shall apply to all urgent or emergent medical services commencing between the hours set out above" (B-1).
• It applies wherever you see the patient: your office, the patient's home, a personal care home or the hospital. (B-2, note 5)
• It also applies to an urgent call billed as 8000 or 8001. (B-2, note 4)
• The time the service started "must be entered on the claim." (B-2, note 3)
• "Claims for services rendered in a physician’s office must include the words “urgent/emergent” on the claim." If the diagnosis code does not show why it was urgent, add a brief comment. (B-2, note 6)
• On a virtual visit, only when you have a continuing relationship with the patient and the visit is urgent or emergent. (Rule 62, Rules-13)

After-hours premium: when it does not apply

• You are paid for that time by on-call pay, or in some other way that is not fee-for-service. One exception: your agreement with Manitoba Health says you may still submit fee-for-service claims. Then the premium can apply. (B-1)
• You are an emergency physician, or you are covering a drop-in emergency clinic or an emergency room. The manual says drop-in emergency clinics "include drop-in/walk-in clinics which maintain regular hours of operation that fall within the periods of time specified in the After Hours Premiums tariffs." (B-1) The manual does not say how this applies to a booked clinic that advertises evening hours. Ask Manitoba Health before you bill 5555 or 5550 in your own regular evening or weekend hours.
• During or after an emergency department shift, when you have chosen or are required to be present in the emergency department. (B-1)
• Obstetrical fees when you induced labour yourself, unless the induction was for one of the medical reasons the manual lists. (B-1)
• Lab services or reading test results, unless done on site in urgent or emergent circumstances. (B-1)
• Reading diagnostic imaging, unless a radiologist does it in urgent or emergent circumstances. (B-1)
• Anticoagulant monitoring (8002). Phone, fax or email communications about a drug coverage application, billed as 8003. (B-1)
• Any service the manual itself says is excluded from the after-hours premium, in that tariff's own notes. (B-2, note 4)

Extended clinic hours premium: when it applies

• It applies to "all medical services commencing between the hours set out above", urgent or not. (A-126)
• The clinic keeps at least 8 regular office hours between 8:00 a.m. and 5:00 p.m. Monday to Friday. An approved Extended Primary Care clinic also qualifies. (A-126)
• "The extended clinic hours are advertised to the public or the clinic’s own patients and the patient has the option for in person availability." (A-126)
• "The time the service commences must be entered on the claim." (A-126)

Extended clinic hours premium: when it does not apply

• "5530 or 5531 may not be claimed with tariffs 5555, 5553, 5550, 5556, 5557 and 5558." (A-126) 5555, 5553 and 5550 are the after-hours premiums. The manual pages we checked do not describe 5556, 5557 or 5558.
• "An extended clinic hours premium may not be claimed for a patient scheduled to be seen before the extended hours period." (A-126)
• Tariffs 8000, 8001, 8002, 8003 and 8005 are not eligible. Neither are "annual management tariffs such as but not limited to CDM and CCM tariffs". CDM is chronic disease management. The manual does not spell out CCM here. (A-126)

Worked example

What is often not billed

The after-hours premium on an urgent call from another physician in the evening, overnight or on a weekend. The extended clinic hours premium never applies to 8001 (A-126). The after-hours premium does, when the call is urgent or emergent (B-2, note 4; B-10). The claim carries the time the call started (B-2, note 3). For 8001 it also carries the name of the physician or registered nurse (extended practice) who made the call, the patient's name and the time the call ended (B-10, note 8). Write in your note why the call was urgent: Manitoba Health can ask for the record to support the claim (B-10, note 10).