Physicians can claim several tariffs for maternity services. Typically, physicians will claim one comprehensive pre-natal assessment, followed by 10 – 12 routine pre-natal visits and one post-natal visit. The following is a list obstetrical visit tariffs and the related rules and guidelines for claiming each tariff (as set out in Rule of Application #33).
Tariff 8400 Comprehensive pre-natal assessment
- Assessment should include full patient history, an inquiry into and examination of all relevant parts or systems, a comprehensive pelvic examination along with the completion of the pre-natal record and advice to the patient;
- Should generally last 20 minutes or longer; otherwise claim as appropriate visit fee (Complete, Regional or Basic visit);
- Should only be billed once per pregnancy, per physician.
Note: When the management of a pregnancy is transferred from a GP to either a GP with obstetrical training, or an Obstetrician an additional comprehensive assessment may be claimed.
Tariff 8401 Pre-natal visit
- A visit should include the necessary history, examination, appropriate record and advice to the patient, including any pregnancy-related counselling or advice to the patient or patient’s representative(s);
- Visits should generally occur at four-week intervals to 28 weeks, every 2nd week up to 36 weeks, and then weekly until delivery;
- Complicated pregnancies may require additional visits; claim all of which as Tariff 8401.
Tariff 8402 Post-natal visit
- A visit should include the necessary history, examination, appropriate record and advice to the patient;
- May only be billed once following delivery during the post-natal period (42 days after delivery);
- Complicated pregnancies may require additional visits, which should be claimed as the appropriate office, home or hospital visit.
For claiming supplementary tariffs concerning Obstetrical care:
- Claim visits that are for conditions unrelated to pregnancy under the appropriate visit fee;
- Necessary laboratory investigations are payable in addition to obstetrical fees;
- Serious complications that require hospitalization prior to delivery are not included in the benefits provided for obstetrical care and should be billed by Special Report (Bill visits, hospital daily care, tests and other fees as if the case were a typical hospital patient).
November 25, 2021