Training or Experience Required to Claim Certain Tariffs

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.

Questions?

Ian Foster
ifoster@docsmb.org
(204) 985-5854

td>Family Practice – Geriatric Consultation

SERVICE

TARIFFS

ORGANIZATION(S)

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
8409 CancerCare Manitoba
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
ECGs 9837, 9838 CPSM
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