Monitoring of Clozapine – Tariff 8004

Tariff 8004 compensates physicians who are responsible for monitoring patients taking clozapine, also sold under the names: Apo-clozapine, Clozaril and Gen-clozapine.

Services encompassed by tariff 8004 include:

  1. Ordering blood tests,
  2. Interpreting results,
  3. Inquiring into possible complications, and
  4. Adjusting the dosage as necessary

Payment of Tariff 8004 is limited to one claim per patient per calendar month.

Claims for additional services provided to a patient (e.g. visits) may be made in addition to this tariff.

Billing Notes

  1. Tariff may be claimed regardless of the location of the patient, and applies to hospital in-patients, personal care home residents and at-home patients.
  2. For ease of billing, some physicians choose one day of the month (e.g., 1st day of month, last day of month etc.) and bill tariff with respect to all patients receiving Clozapine on this same day each month. Physicians may also choose to bill tariff on a quarterly basis, indicating the service date for each month for which they are billing. Either method of billing is acceptable to Manitoba Health provided some services, such as test interpretation, is provided.
  3. Although there is no prohibition against claiming tariff on same service date as a patient visit, doing so will result in one of the claims being “flagged” and requiring “manual intervention” for Manitoba Health to process. Although this claim generally will ultimately be paid, it is important to monitor your remittance statements to ensure that the claim is, in fact, paid. To avoid delays, some physicians elect to claim the tariff with a service date on the 1st (or last) Saturday or Sunday (non-office day) of each month, so as to avoid the possibility of the selected service date coinciding with the date of a patient visit.

Tariff should be claimed by the physician most responsible for monitoring the patient’s condition respecting the Clozapine dosage.

Questions?

Roger Jamieson
rjamieson@docsmb.org
(204) 985-5849

 

Updated: May 2017