How do I bill a virtual visit in Manitoba?

The fees

When it applies and when it does not

Which tariff fits the visit

• 8345. The manual notes: “Generally, less than ten (10) minutes of physician time is required.” (A-121)
• 8321. “The visit shall be a minimum of ten (10) minutes of physician time or the patient is over 65 years of age.” (A-121)
• The age premium starts at age 65. This condition says “over 65”. The manual does not say how it treats a patient who is exactly 65.
• 8340. By phone only. “8340 shall be limited to patients with no known history with the physician.” (A-122)
• 8442. “8442 may only be provided as part of a Continuing Patient Relationship as described in Rule of Application 62.” (A-122) Pages A-121 to A-122 give no description and no minimum time for 8442.
• ~8350. By video only. It is for two or more distinct complaints or problems. The visit needs all of these (A-121 to A-122):
  • a history of the complaints;
  • an examination of the parts or systems related to them;
  • a review of all pertinent investigations;
  • a complete written record and advice to the patient;
  • a minimum of 20 minutes of physician time;
  • “Start and stop times must be included on the claim.”
• The tilde (~) marks 8350 as a provisional tariff, one still under evaluation. Rule 56 says that for non-surgical services “a descriptive report, including the length of time for the procedure or service, must be submitted with any claim for a provisional tariff.” That is a written description of the visit. (Rules-12)

When it applies

• Telephone means “synchronous audio-only communication (no visualization)”. Video means “2-way synchronous video-conference (audio and video visualization)”. Synchronous means live: you and the patient take part at the same time. (Rule 62, Rules-13)
• “When 8345, or 8321 is provided by telephone the service must be part of a continuing patient relationship as described in Rule of Application 62.” (A-122)
• A continuing patient relationship means any one of these (Rule 62, Rules-13):
  • you provided at least one insured service to the patient in the preceding 24 months;
  • the patient is on the panel of another physician in your practice group who provided an insured service in the preceding 24 months, and you have access to the patient's electronic medical record;
  • you provide the service through a contractual arrangement with Manitoba, a Health Authority or under the Physician Services Agreement;
  • another health care provider or health care service in Manitoba referred the patient to you;
  • the visit is for psychiatric care or psychotherapy.
• If you decide during the virtual visit that the patient needs to be assessed in person, bill a basic or intermediate virtual visit. “The subsequent in person visit may be billed at the appropriate in-person examination tariff in addition.” (Rule 62, Rules-13)
• Manitoba Health adds an age premium to 8321, 8442 and ~8350 on its own: 10% for patients aged 65 to 69 and 20% for patients 70 or older. (A-119)
• The service must be documented. Manitoba may ask for the documentation to support the claim. (Rule 62, Rules-13)

When it does not apply

• Services must be “personally rendered by the physician”. No claim may be made when only someone acting for you takes part, such as a nurse or clerk. (Rule 62, Rules-13)
• “Maximum of one virtual visit per patient per day may be claimed.” (Rule 62, Rules-13)
• You and the patient must both be in Manitoba at the time of the service. The exception is when the province has authorized it. The manual's words are “except where otherwise authorized by the Provincial CMO or designate”. (Rule 62, Rules-13)
• After-hours premiums apply to a virtual visit only when there is a continuing patient relationship and the visit is an urgent or emergent service. (Rule 62, Rules-13)

Worked example

What is often not billed

The age condition. A telephone or video visit with a patient over 65 meets the 8321 condition even when it is shorter than 10 minutes. 8321 pays $41.02 and 8345 pays $29.28 (A-121). Manitoba Health adds the age premium to 8321 on its own (A-119). The note must still record the visit. By telephone, the patient must also have a continuing patient relationship with you.