New Pediatric Fee Codes

 

New Pediatric Fee Codes


MSP has added 4 new Pediatric fee codes to the payment schedule. All 4 codes are listed under ‘Miscellaneous,’ and are extra incentives for critical care and after office hours.

If you haven’t started using them, here’s an overview of each one:

1. Pediatric Fee Code P01455: Adult and Pediatric Critical Care
2. Pediatric Fee Code P50571, P50572, P50573: After Hours Surcharge


Pediatric Fee Code P01455: Adult and Pediatric Critical Care

P01455 has been added to the section of Critical Care under the heading ‘Miscellaneous.’ It’s available on September 1, 2019 and acts as an extra bonus on top of other critical care bonuses.

It’s restricted to Critical Care physicians, and can only be used if you’ve previously claimed 01450 (Adult and Pediatric Critical Care 1st day modifier).

Code Description MSP Fee
01450 Adult and Pediatric Critical Care 1st day modifier - extra 42.87
01455 Adult and Pediatric Critical Care (2nd day onward) Extra $7.26

01455 is only payable when it’s used in addition to any one of the following fee codes:

01421: Critical care (icu) - 2nd to 7th day (incl.)
01422: Ventilatory support (icu) - 2nd to 7th day (incl.)
01423: Comprehensive care (icu) - 2nd to 7th day (incl.)
01431: Critical care (icu) - 8th to 30th day
01432: Ventilatory support (icu) - 8th to 30th day
01433: Comprehensive care (icu) - 8th to 30th day
01441: Critical care (icu) - 31st day onward
01422: Ventilatory support (icu) - 2nd to 7th day (incl.)
01443: Comprehensive care (icu) - 31st day onward


Pediatric Fee Code P50571, P50572, P50573 : Pediatric After Hours Surcharge

Pediatric Fee Codes P50571, P50572, and P50573 have been added to the section of Pediatrics under the heading ‘Miscellaneous.’ They became effective on April 1, 2019.

All 3 fee codes act as an extra incentive used in addition to other premiums and fee codes. They are all restricted to Pediatrics and Pediatric Cardiology.

You cannot these fee codes if you’re a full time (or part time) onsite physician who is providing coverage in drop-in emergency clinics or hospital emergency rooms.

Code Description MSP Fee
50571 Pediatric Evening Surcharge (services between 1800 hrs and 2300 hrs)$30.80
50572 Pediatric Saturday, Sunday, and Statutory Holiday surcharge (services between 0800 hours and 2300 hours)$30.80
50573Pediatric night surcharge (services between 2300 hours and 0800 hours) $95.00

They are only payable only in addition to:

00510: Consultation, paediatrics.
00550: Consult Pediatrics Extended, exceeding 52 minutes.
00551: Consult Pediatrics Extended, exceeding 68 minutes.
00585: Diabetic Ketoacidosis (dka)- 1st day management.
01511: Critical care medicine - Neonatal icu - level a - day 1.
01512: Critical care medicine - Neonatal icu - level b - day 1
01513: Critical care medicine - Neonatal icu - level c - day 1

They are also only payable in addition to the following out-of-office premiums:

01200: Out of office premiums 1800-2300 call-out charge - evening
01201: Out of office premiums 2300-0800 call-out charge - night
01202: Out of office premiums - Saturday, sunday, or stat holiday -call-out charge
01205: Out of office premiums - 1800-2300 surcharge - nonoperative
01206: Out of office premiums - 2300-0800 surcharge - nonoperative
01207: Out of office premiums - Weekend and stat/holiday surcharge - nonoperative


Retroactive Claims

Although the effective date for Pediatric Fee Codes P50571, P50572, and P50573 is April 1, 2019, MSP has approved these fee codes as retroactive. This means you can submit P50571, P50572, and P50573 for dates that are more than 90 days old.

However, the maximum retroactive period is six months, which means you can submit claims as far back as October 1st, 2018.

In order to get these claims approved you’ll need to submit them with submission code A.

Submission Code A

Submission code A is only used on a claim when a claim doesn’t meet any other criteria for any of the other submission codes (C, X, I and W). Retroactive claims always fall under submission code A. 

To use submission code A you need the following: 

  • Written request (For the new Pediatric Fee Codes, MSP has already pre-approved the request). 

  • Requests must include the date range of the claims, number of claims, value of claims and the fee items involved. 

Just remember that once you submit retroactive claims, they are still subject to the usual processing, and can therefore sometimes come back as rejected. 


Looking for more MSP Pediatric billing codes? Use our search-able database to find any fee code.