Certain tariffs in the Physician’s Manual may only be claimed by physicians with specific credentials, training or experience.
For many tariffs e.g., visit page tariffs, the physician’s Manitoba Health designated bloc of practice is sufficient. No other action is required in order to submit claims for these tariffs. A physician’s Manitoba Health designated bloc of practice is determined by her/his College of Physicians and Surgeons of Manitoba (CPSM) designated specialty. (Speciality Restricted Fee Codes – Eligibility)
Certain other tariffs specifically indicate that claims are only permitted for physicians with additional training or experience. Generally, claims for these servicest will not be paid until confirmation of the additional training/experience has been acknowledged by Manitoba Health.
The organization/entity responsible for determining the acceptability of a physician’s training/experience varies from tariff to tariff (see table below).
In some cases, Doctors Manitoba and Manitoba Health are required to agree on which physicians are approved to claim a tariff. (Doctors Manitoba has designated physician experts to provide it with recommendations in this regard.)
In other cases, a service is part of the Manitoba Quality Assurance Program (MANQAP) and restricted to those physicians approved by the CPSM.
In yet other cases, the determination as to a physician’s training/experience is made by another entity or individual such as CancerCare Manitoba or a WRHA program director.
It is usually very difficult to obtain payment from Manitoba Health on a retroactive basis (i.e., if confirmation of training/experience is not obtained before a service is provided). Therefore, you should obtain confirmation of the acceptability of your training/experience, and submit this information to Manitoba Health before providing the service. This is especially important where you intend to introduce a new service into your practice.
Contact Doctors Manitoba for further advice or assistance with the approval process.
td>Family Practice – Geriatric Consultation
|Child Developmental Assessment/ Feeding Assessment||8552, 8404, 8555, 8558, 8560, 8562, 8564, 8597||Doctors Manitoba & Manitoba Health|
|Paediatric Adolescent Behaviour Therapy||8582||Doctors Manitoba & Manitoba Health|
|Orthopaedic Spinal Consultation||8440||WRHA Medical Director of Surgery and recognized by either the Manitoba Orthopaedic Society or Division of Neurosurgeons, U of M|
|Malignant Disease Specialist Visit Page||All Visit Page tariffs||CancerCare Manitoba|
|Subcutaneous Injection Chemotherapeutic Rods||2226, 2228||CancerCare Manitoba|
|Complete or extensive
re-examination of cancer patient
|Monitoring of Oral Chemotherapeutic Agent||8405||CancerCare Manitoba|
|Plasmapherisis||2605, 2606, 2607||WRHA, Head (or designate), Department of Medicine|
|Chronic Pain Management||8570, 8571||WRHA Chief Medical Officer or VP Medical Brandon RHA|
|Pulsed Radiofrequency Ablation||5800, 5802, 5805, 5806, 5807||WRHA Medical Director, Anesthesia Program/Medical Director for the Provincial Pain Management Service|
|Sleep Study||8872, 8873, 8874||Doctors Manitoba & Manitoba Health|
|Botulinum Toxin for Hyperhidrosis||9731, 9733, 9735||Doctors Manitoba Consultant Group|
|Advanced audio-vestibular system tests||9788, 9797, 9709, 9712, 9714, 9723, 9755, 9756, 9747, 9748, 9750||CPSM|
|Lab Procedures||All tariffs in Section W||CPSM – MANQAP|
|Intra-operative Electrocorticograhy||5100||CPSM, Head (or designate) Section of Neurology,
U of M
|Psychiatry Consultation-Geriatric Patient||8622||Certification as a geriatric psychiatrist Royal College of Physicians Surgeons of Canada or WRHA Mental Health Program|
|Endoscopic Sinus or Transnasal Services||2001, 2002, 2003, 2004, 2005||Head of the WRHA Otolaryngology program|
|Family practice Geriatric Consultation||8617||General Practitioner with Care of the Elderly certificate|
|Portable Sleep Studies||8875, 8876||WHRA Sleep Program Director|
|Echocardiography||9729, 9730, 9732, 9736, 9739, 9741||WRHA Chief Medical Officer or Vice president Medical of the Brandon Regional health Authority|
Updated: December 2016