RACE billing information for family physicians, nurse practitioners, and midwives

• Conversation must take place within two hours of the FP’s request and must be physician to physician. Not payable for written communication (i.e. fax, letter, email).

• Fee Includes:

  • Discussion with the specialist of pertinent family/patient history, history of presenting complaint, and discussion of the patient’s condition and management after reviewing laboratory and other data where indicated.

  • Developing, documenting and implementing a plan to manage the patient safely in their care setting.

  • Communication of the plan to the patient or the patient’s representative.

  • The care plan must be recorded in patient chart and must include patient identifiers, reason for the care plan, list of co-morbidities, safety risks, list of interventions, what referrals to be made, what follow-up has been arranged

• Not payable to the same patient on the same date of service as fee item PG14077.

• Not payable to physicians who are employed by, or who are under a contract to a facility, who would otherwise have provided the service as a requirement of their employment or contract with the facility; or physicians working under salary, service contract or sessional arrangement.

• Include start time in time fields when submitting claim.

• Not payable for situations where the primary purpose of the call is to:

  • Book an appointment

  • Arrange for transfer of care that occurs within 24 hours

  • Arrange for an expedited consultation or procedure within 24 hours

  • Arrange for laboratory or diagnostic investigations

  • Convey the results of diagnostic investigations

  • Arrange a hospital bed for the patient.

  • Obtain non-urgent advice for patient management (i.e. not required within the next 24 hours).

• Limited to one claim per patient per physician per day.

• Out-of-Office Hours Premiums may not be claimed in addition.

• Maximum of 6 (six) services per patient, per practitioner, per calendar year.

• Payable in addition to a visit on the same date.

• Reciprocal billing for out-of-province (Yukon) patients requires: code for the province/territory of patient residence, PHN, name, sex, date of birth, and patient home address.

• For physicians enrolled in the LFP Payment Schedule conferencing, consulting, and meeting with other physicians and/or other health professionals for a specific patient(s) is an eligible Indirect Patient Care (98011) activity. Click here to review the most up to date payment schedule to ensure appropriate billing for time spent on a RACE call, or contact LFP.billing@doctorsofbc.ca.

More Details:

• Read more about code PG14018

• For members of the Society of General Practitioners of BC, click here.