What is tariff 8529 in Manitoba?

Fee box

When it applies

• It is a visit “for a problem specific Assessment”. The manual says it “shall be comprised of”: “A history of the presenting complaint(s)”; “An examination of the parts or systems related to the presenting complaint(s)”; “A review of all pertinent investigations”; and “A complete written record and advice to the patient.” (A-119 to A-120)
• “The visit shall be a minimum of ten (10) minutes of physician time or the patient is over 65 years of age.” (A-120) So a visit with a patient over 65 meets this condition even when it takes less than 10 minutes. This condition is separate from the age premium, which starts at age 65.
• It can be claimed as a subsequent visit. Rule 6 says: “if the patient has been seen by the same doctor within any sixty (60) day period for the same condition, only a subsequent visit may be claimed for any visit following the initial visit.” (Rules-2) The 8529 description includes “Subsequent Visit”. (A-119)
• Well baby care is part of the tariff's own description. (A-119)
• “Tariff 9795 (cytological smears for cancer screening) may be claimed in addition to tariff 8529, where appropriate.” (A-120)
• “Tariff 8448 may be claimed in addition to 8529 where a pelvic examination is provided.” (A-120) For a patient who is not pregnant, Rule 17 lists what a pelvic exam usually includes where indicated (Rules-5):
  • inspection of the vulva and perineum
  • a speculum exam of the vault and cervix
  • a bimanual exam of the uterus and ovaries
  • a pelvic-rectal exam
• The manual says an age premium is applied automatically to 8529: 10% for patients aged 65 to 69, and 20% for patients 70 or older. (A-119) Manitoba Health adds it. It is not a separate line on the claim.

When another tariff fits better

• A visit under 10 minutes with a patient who is not over 65: the manual describes 8509 (Regional Basic Visit). It pays $29.28. “Generally, less than ten (10) minutes of physician time is required.” (A-120)
• A full history and an exam of “all relevant parts or systems required to make a diagnosis or differential diagnosis”: 8540 (Complete History and Physical Examination). It pays $93.66. (A-119) Within 60 days of an earlier visit by you for the same condition, Rule 6 allows only a subsequent visit. For certain illnesses such as the continuing management of a chronic illness, a claim for a more extensive exam within the 60 days “may be allowed but only by Special Report”. This applies when you decide that exam is necessary. (Rules-2)
• “Two or more distinct complaints or problems” and “a minimum of twenty (20) minutes of physician time”: 8640 (Extended Visit). It pays $70.00. (A-120) The manual prints it as ~8640. The ~ marks a provisional tariff. (Rule 56, Rules-12)
• A telephone or video visit: 8529 is listed under “Office, Home Visits”. The virtual tariff is 8321 (intermediate virtual visit by telephone or video). It pays $41.02. It has the same 10-minute or over-65 condition. (A-121)

Worked example

What is often not billed

A smear or a pelvic exam done during an 8529 visit is its own line on the claim. Bill 9795 ($25.15) when you take a cytological smear for cancer screening, where appropriate. Bill 8448 ($21.23) when you provide a pelvic examination. (A-120)