Specialist Group Medical Visits

This module is a general guideline on billing Specialist Group Medical Visits. For greater details, please refer to Specialist Services Committee Initiated Listings section of the Medical Services Commission Payment Schedule.

A Group Medical Visit (GMV) provides medical care in a group setting. A requirement of a GMV is a 1:1 interaction between each patient and the attending physician. Because this is a time-based fee, concurrent billing for other services during the time of the GMV is not permitted. The physician must be physically present at the GMV for the majority of each time interval billed. While portions of the GMV may be delegated to a non-physician staff member, the specialist must be present for a majority of the GMV and assumes clinical responsibility for the patients in attendance.

Group Medical Visits are an effective way of leveraging existing resources; simultaneously improving quality of care and health outcomes, increasing patient access to care and reducing costs. Group Medical Visits can offer patients an additional health care choice, provide them support from other patients and improve the patient-physician interaction. Physicians can also benefit by reducing the need to repeat the same information many times and free up time for other patients.

Appropriate patient privacy is always maintained and typically these benefits result in improved satisfaction for both patients and physicians. The Group Medical Visit is not appropriate for advice relating to a single patient. It applies only when all members of the group are receiving medically required treatment (i.e. each member of the group is a patient). The Group Medical Visits are not intended for activities related to attempting to persuade a patient to alter diet or other lifestyle behavioural patterns other than in the context of the individual medical condition.

The many benefits for the patient are:

  • Improve quality of care and health outcomes
  • Increase patient access to care
  • Provide an additional health care choice
  • Provide support from other patients
  • Learn from questions posed by other patients
  • Improve the patient-physician interaction

The many benefits for the physicians are:

  • Reduce the need to repeat the same information many times
  • Free up time for other patients
  • Improve the patient-physician interaction
  • A well-informed, relaxed patient if the case proceeds to surgical/diagnostic procedures

This fee is not intended for provision of group psychotherapy (00663, 00664, 00665, 00667, 00668, 00669, 00670, 00671, 00672, 00673, 00674, 00675, 00676, 00677, 00678, 00679, 00680, 00681).

The Group Medical Visit fees are billable when all members of the group are referred patients of the Specialist.

Below are the different fee codes for the number of patients treated and the notes pertaining to the Group Medical Visit fees:

Fee per patient, per ½ hour

G78763......................................................................................Three patients
G78764.......................................................................................Four patients
G78765.......................................................................................Five patients
G78766.......................................................................................Six patients
G78767.......................................................................................Seven patients
G78768.......................................................................................Eight patients
G78769.......................................................................................Nine patients
G78770.......................................................................................Ten patients
G78771.......................................................................................Eleven patients
G78772.......................................................................................Twelve patients
G78773.......................................................................................Thirteen patients
G78774.......................................................................................Fourteen patients
G78775.......................................................................................Fifteen patients
G78776.......................................................................................Sixteen patients
G78777.......................................................................................Seventeen patients
G78778.......................................................................................Eighteen patients
G78779.......................................................................................Nineteen patients
G78780.......................................................................................Twenty patients
G78781.......................................................................................Greater than 20 patients

Notes:

i) Submit a separate claim for each patient.

ii) Each patient must have an active referral.

iii) Start and end times required in both the medical record and time fields in the claim.

iv) Not payable with any other services for the same patient on the same day by the same physician.

v) If multiple physicians are involved, the group should be divided for claims purposes, with each physician claiming the appropriate rate for only the patients in their own fraction of the group. The claim note and patient chart should specify: a. Number of people in entire group b. Number of patients billed by billing physician

Billing Examples

Example 1

A Group Medical Visit was rendered for forty-six minutes by a Cardiologist with five referred patients regarding their heart condition.
The Cardiologist may bill:
Fee item 78765 x 1 per patient which must be submitted separately for each patient.

Example 2

A Group Medical Visit was rendered for one hour by an Endocrinologist with ten referred patients regarding their diabetic condition.
The Endocrinologist may bill:
Fee item 78770 x 2 per patient which must be submitted separately for each patient.

Example 3

A Group Medical Visit was rendered for thirty minutes by two General Surgeons with twenty referred patients regarding endoscopic procedures.
Each General Surgeon may bill for ten patients:
Fee item 78770 x 1 per patient which must be submitted separately for each patient.

Example 4

A Group Medical Visit was rendered for thirty minutes by two Rheumatologists with seventeen referred patients regarding their arthritic condition.
The first Rheumatologist may bill for eight patients:
Fee item 78768 x 1 per patient which must be submitted separately for each patient.
The second Rheumatologist may bill for nine patients:
Fee item 78769 x 1 per patient which must be submitted separately for each patient.

Example 5

A Group Medical Visit was rendered for one hour by a Nephrologist with twelve referred patients regarding their renal condition. Three patients left the group after the first half hour and the remaining nine patients continued with the session for another half hour.

For the first half hour, the Nephrologist may bill for twelve patients:
Fee item 78772 x 1 per patient which must be submitted separately for each patient.

For the second half hour, the Nephrologist may bill for nine patients:
Fee item 78769 x 1 per patient which must be submitted separately for each patient.

Tips:


The start and end time of the Group Medical Visit must be provided in the time field on the claim submission. If the times are not provided, the claim will be refused with explanatory codes YY CF.

YY (pre-edit system refusal. See secondary explanatory code(s)) CF (time called or time service was rendered is missing or invalid)

The Group Medical Visits fees are not billable with other listings, if another service was billed by the same physician for the same date, the claim will be refused with explanatory code K3.

K3 (processed according to the description of the fee item, or the note relating to the fee item in the MSC Payment Schedule)

When a Group Medical Visit is rendered by multiple Specialists, a note record indicating the number of people in entire group, number of patients billed by billing physician, of the patients billed by the billing physician, how many were to each insurer and name of any other billing physicians.

Disclaimer: MSP Tutor is intended to provide a guide for physicians and medical office assistants in billing claims to MSP. For definitive information on fee-for-service fee item codes and amounts, consult the current MSC Payment Schedule. If a discrepancy exists between the information contained in MSP Tutor and the MSC Payment Schedule, the information in the Payment Schedule will prevail.

 

 

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