MANITOBA PHYSICIAN’S MANUAL

Table of Contents

MANITOBA

PHYSICIAN¡¯S MANUAL

April 1, 2024

Issued by:

The Minister of Health

manitoba.ca/health/manual

April 1, 2024

i

TABLE OF CONTENTS

TABLE OF CONTENTS ................................................................................................................................................................. II

NUMERIC TARIFF INDEX ..............................................................................................................................................................I

INTRODUCTION............................................................................................................................................................................ 1

LEGISLATION AND REGULATIONS .............................................................................................................................................. 1

CONTACT INFORMATION ............................................................................................................................................................ 1

Practitioner Registry/User Site Maintenance ........................................................................................................................... 1

Claims Unit¡ªClaims Enquiry ................................................................................................................................................. 1

Registration/Client Services ..................................................................................................................................................... 2

Shared Health Service Desk..................................................................................................................................................... 2

CLAIMS SUBMISSION AND PAYMENT PROCEDURES................................................................................................................... 1

Claims Processing Summary (See Parts I-VII for details) ....................................................................................................... 1

Part I¡ªBilling and Provision of Services ................................................................................................................................ 2

Part II¡ªMethod of Claims Submission ................................................................................................................................... 2

Payment Cycle ......................................................................................................................................................................... 2

Six (6) Month Deadline for Submission of Claims .................................................................................................................. 2

Reciprocal Billing for Non-Manitoba Residents (Canadians) ................................................................................................. 3

Patient Eligibility (Coverage under Provincial Health Plan) ................................................................................................... 3

Part III¡ªRemittance Advice ................................................................................................................................................... 4

Pending Claims (EOB ¡°77¡±) .................................................................................................................................................... 5

Part IV¡ªFee Differentials ....................................................................................................................................................... 5

Part V¡ªInterest ....................................................................................................................................................................... 6

Part VI¡ªBy Report ................................................................................................................................................................. 6

Part VII¡ªDisputes .................................................................................................................................................................. 7

RULES OF APPLICATION ............................................................................................................................................................. 1

1¡ªVisit or Examination .......................................................................................................................................................... 1

2¡ªSpecialist ............................................................................................................................................................................ 1

3¡ªSpecial Call/Special Call Rule of Application 3 ................................................................................................................ 1

Exclusions ................................................................................................................................................................................ 2

4¡ªComplete History and Physical Examination..................................................................................................................... 2

5¡ªRegional History and Examination .................................................................................................................................... 2

6¡ªSubsequent Visit ................................................................................................................................................................ 2

7¡ªConsultation (Amended April 1, 2015).............................................................................................................................. 3

8¡ªConsultation (Amended October 1, 2008) ......................................................................................................................... 3

9¡ªTreatment/Procedures Performed By A Consultant ........................................................................................................... 3

(Amended October 1, 2008) .................................................................................................................................................... 3

10¡ªSubsequent Consultations (Amended October 1, 2008) .................................................................................................. 3

Table of Contents

11¡ªDeleted (October 1, 2008) ............................................................................................................................................... 3

12¡ªHospital Care ................................................................................................................................................................... 3

13¡ªSupportive Care ............................................................................................................................................................... 4

14¡ªConcomitant Care ............................................................................................................................................................ 4

15¡ªDeleted (April 1, 2005) .................................................................................................................................................... 4

16¡ªPersonal Care Home Care ................................................................................................................................................ 4

17¡ªPelvic Examinations (Amended October 1, 2023)........................................................................................................... 5

17(c) - Deleted (October 1, 2023)............................................................................................................................................ 5

17(d) - Deleted (October 1, 2023) ........................................................................................................................................... 5

17(e) - Deleted (October 1, 2023)............................................................................................................................................ 5

18¡ªChronic Care .................................................................................................................................................................... 5

19¡ªPremature Baby Care ....................................................................................................................................................... 5

20¡ªChild/Infant/Newborn (Amended April 1, 2019) ............................................................................................................ 6

Surgical Rules .......................................................................................................................................................................... 6

21¡ªAsterisked Procedure ....................................................................................................................................................... 6

22¡ªIndependent Procedure .................................................................................................................................................... 6

23¡ªBenefits for Major Surgical Services ............................................................................................................................... 6

24¡ªPreoperative Care ............................................................................................................................................................ 6

25¡ªMultiple Surgical Services¨CSame Incision ...................................................................................................................... 6

26¡ªMultiple Surgical Services¨CSeparate Incisions ................................................................................................................ 6

27¡ªMultiple Surgical Services Performed by Different Surgeons ......................................................................................... 6

28¡ªBilateral Surgical Services ............................................................................................................................................... 7

29¡ªAdditional Surgical Services ........................................................................................................................................... 7

30¡ªTwo Surgeons .................................................................................................................................................................. 7

31¡ªPostoperative Surgical Care ............................................................................................................................................. 7

32¡ªSurgical Assistant ............................................................................................................................................................ 7

33¡ªObstetrics (Amended April 1, 2019)................................................................................................................................ 7

34¡ªFractures .......................................................................................................................................................................... 8

35¡ªFractures Requiring No Reduction .................................................................................................................................. 8

36¡ªMultiple Fractures............................................................................................................................................................ 8

37¡ªTwo Closed Reductions ................................................................................................................................................... 8

38¡ªRevision of a Closed Reduction ....................................................................................................................................... 8

39¡ªClosed Reduction ............................................................................................................................................................. 9

40¡ªOpen Reduction is Followed by a Second Open Reduction ............................................................................................ 9

41¡ªCompound Fractures........................................................................................................................................................ 9

42¡ªOpen Reduction (Amended April 15, 2019) .................................................................................................................... 9

43¡ªSecondary Amputation or Excision ................................................................................................................................. 9

44¡ªDialysis ............................................................................................................................................................................ 9

45¡ªChronic Renal Failure ...................................................................................................................................................... 9

46¡ªDeputizing ....................................................................................................................................................................... 9

Guidelines on Concomitant Care ........................................................................................................................................... 10

47¡ªConcomitant Care .......................................................................................................................................................... 10

April 1, 2024

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48¡ªConcomitant Care/Major Additional Diagnoses ............................................................................................................ 10

49¡ªDeleted (April 1, 2007) .................................................................................................................................................. 12

50¡ªDeleted (April 1, 2007 ................................................................................................................................................... 12

51¡ªDeleted (April 1, 2007) .................................................................................................................................................. 12

52¡ªDeleted (April 1, 2007) .................................................................................................................................................. 12

53¡ªDeleted (April 1, 2007) .................................................................................................................................................. 12

54¡ªDeleted (April 1, 2007) .................................................................................................................................................. 12

55¡ªExtraordinary Circumstance .......................................................................................................................................... 12

56¡ªProvisional Tariffs ......................................................................................................................................................... 12

57¡ªMinimum Fee Under General Anesthesia ...................................................................................................................... 12

58¡ªRegistered Nurse (Extended Practice) ........................................................................................................................... 12

59¡ªClinical Assistant ........................................................................................................................................................... 12

60¡ªHead and Neck Surgery (Amended October 1, 2023).................................................................................................... 13

61¡ªTechnical Fees ............................................................................................................................................................... 13

62¡ªVirtual Medicine Visit Services ¨C Definition................................................................................................................. 13

63¡ª Visit on the same day of procedure............................................................................................................................... 14

Anesthesia .............................................................................................................................................................................. 14

VISITS/EXAMINATIONS¡ªINTERNAL MEDICINE (01).............................................................................................................A-1

Office, Home Visits .............................................................................................................................................................A-1

Continuing Patient Care Management by Medical Specialists ........................................................................................A-2

Virtual Visits ........................................................................................................................................................................A-3

Special Call¡ªSee General Schedule ...................................................................................................................................A-3

Hospital Care .......................................................................................................................................................................A-3

Concomitant Care ................................................................................................................................................................A-5

Chronic Care¡ªSee General Schedule .................................................................................................................................A-5

NEUROLOGY (01-1) .................................................................................................................................................................A-6

Office, Home Visits .............................................................................................................................................................A-6

Continuing Patient Care Management by Medical Specialists ........................................................................................A-7

Virtual Visits ........................................................................................................................................................................A-8

Special Call¡ªSee General Schedule ...................................................................................................................................A-8

Hospital Care .......................................................................................................................................................................A-8

Concomitant Care .............................................................................................................................................................. A-11

Chronic Care¡ªSee General Schedule ............................................................................................................................... A-11

GERIATRIC MEDICINE (01-2) ............................................................................................................................................... A-12

Office, Home Visits ........................................................................................................................................................... A-12

Continuing Patient Care Management by Medical Specialists ...................................................................................... A-14

Virtual Visits ...................................................................................................................................................................... A-15

Special Call¡ªSee General Schedule ................................................................................................................................. A-15

Hospital Care ..................................................................................................................................................................... A-15

Concomitant Care .............................................................................................................................................................. A-17

Chronic Care¡ªSee General Schedule ............................................................................................................................... A-17

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RHEUMATOLOGY MEDICINE (01-3) ..................................................................................................................................... A-18

Office, Home Visits ........................................................................................................................................................... A-18

Continuing Patient Care Management by Medical Specialists ...................................................................................... A-19

Virtual Visits ..................................................................................................................................................................... A-20

Special Call¡ªSee General Schedule ................................................................................................................................. A-20

Hospital Care ..................................................................................................................................................................... A-20

Concomitant Care .............................................................................................................................................................. A-21

Chronic Care¡ªSee General Schedule ............................................................................................................................... A-22

CARDIOLOGY (01-4) ............................................................................................................................................................. A-23

Office, Home Visits ........................................................................................................................................................... A-23

Continuing Patient Care Management by Medical Specialists ...................................................................................... A-24

Virtual Visits ..................................................................................................................................................................... A-25

Special Call¡ªSee General Schedule ................................................................................................................................. A-25

Hospital Care ..................................................................................................................................................................... A-25

Concomitant Care .............................................................................................................................................................. A-27

Chronic Care¡ªSee General Schedule ............................................................................................................................... A-27

GASTROENTEROLOGY (01-5) ............................................................................................................................................... A-28

Office, Home Visits ........................................................................................................................................................... A-28

Continuing Patient Care Management by Medical Specialists ...................................................................................... A-29

Virtual Visits ..................................................................................................................................................................... A-30

Special Call¡ªSee General Schedule ................................................................................................................................. A-30

Hospital Care ..................................................................................................................................................................... A-30

Concomitant Care .............................................................................................................................................................. A-31

Chronic Care¡ªSee General Schedule ............................................................................................................................... A-32

NEPHROLOGY (01-6) ............................................................................................................................................................. A-33

Office, Home Visits ........................................................................................................................................................... A-33

Continuing Patient Care Management by Medical Specialists ...................................................................................... A-34

Virtual Visits ..................................................................................................................................................................... A-35

Special Call¡ªSee General Schedule ................................................................................................................................. A-35

Hospital Care ..................................................................................................................................................................... A-35

Concomitant Care .............................................................................................................................................................. A-36

Chronic Care¡ªSee General Schedule ............................................................................................................................... A-37

ALLERGY & CLINICAL IMMUNOLOGY (01-7) ...................................................................................................................... A-38

Office, Home Visits ........................................................................................................................................................... A-38

Continuing Patient Care Management by Medical Specialists ...................................................................................... A-39

Virtual Visits ..................................................................................................................................................................... A-40

Special Call¡ªSee General Schedule ................................................................................................................................. A-40

Hospital Care ..................................................................................................................................................................... A-40

Concomitant Care .............................................................................................................................................................. A-41

Chronic Care¡ªSee General Schedule ............................................................................................................................... A-41

April 1, 2024

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