General :
- Effective April 1, 2021
- Includes the abolition of Letters of Agreement 294 and 295 and Agreements 206 and 457
- All services are now billed to the facility code of the detention facility and are no longer considered to be home visits.
Designation
A physician who bills under the terms of EP 55 must be designated by the CISSS or CIUSSS of the territory to which the detention facility belongs by means of a notice of service approved by the joint committee. He or she may then change his or her mode each year, on the date of designation.
Types of services covered by EP 55
- Medical services
- Medico-administrative services
- On-call (fee-for-service, regardless of payment method chosen)
- Teaching EP 42 – 19910/19913 or 19916/19919 (billable, regardless of payment method chosen)
Modes of remuneration
A physician who wishes to practice in a detention centre must select one of the following remuneration modes when submitting his or her notice of service, regardless of his or her usual mode or the modes of other physicians in the facility:
- Fixed fee
- Hourly rate
- Fee for service
Fixed fee / Hourly rate
- Fee statements must be signed by the authorized person at the CISSS or CIUSSS.
- A responsibility premium of $40.45 is added to the remuneration of 95% of all hours of professional activity billed. The premium is paid quarterly.
- New codes to use:
-
- 292257- Medical services
- 292258- Medico-administrative services
- Dispensing area: Office
Fee-for-service
The physician paid on a fee-for-service basis may bill according to the following nomenclature and fee schedule:
- 15891- Minor one-time visit to a detention facility ($30)
- 15892- Complex one-time visit to a detention facility ($60)
- 08772- Clinical intervention – first 30 minutes ($60)
- 08773- Clinical intervention – additional 15 minutes ($30)
- 15893- Visit requiring urgent travel to a detention facility ($300)
- 08774- Extra charge for clinical intervention during an emergency trip ($50)
- 19969- Medico-administrative activities, full 15-minute period ($25)
On-call (always billed on a fee-for-service basis)
A physician performing on-call duty is paid for one week of on-call duty. Once a detention facility is transferred to EP 55, the physician(s) assigned to on-call duty at that facility may bill for the number of quarterly lump-sum amounts proportional to the number of weeks of on-call duty they covered during the quarter:
- Code 19860 – Lump-sum amount;
- Billed once a quarter, on any date;
- Refer to Appendix I of EP 55 –On-call duty at detention facilities for the number of lump-sum amounts available per quarter.
Services rendered during on-call duty are paid on a fee-for-service basis under the terms of the agreement. However, the following services rendered during on-call duty are paid according to the office fee schedule:
- Diagnostic or therapeutic procedure
- Procedure under Tab D – Anesthesia-Resuscitation
- Procedure under Tab E – Surgery
- Death certificate
- #DISPO on all procedures
Surcharge for unfavourable working hours
When the surcharges for unfavourable hours in the General Agreement are applicable, the detention facility is deemed to be an office.
Services requested for third parties or uninsured persons
Services rendered to incarcerated patients who are under the jurisdiction of one of the following may not be claimed from RAMQ:
- Immigration and Refugee Board of Canada;
- Correctional Service of Canada or Royal Canadian Mounted Police;
- Any other police department.
