Alberta SOMB 2026: Verified Billing Codes for Family Physicians
A plain-language reference to the Alberta Schedule of Medical Benefits (SOMB) 2026 codes family physicians use daily. Every code, description, and fee on this page is sourced directly from the Alberta Health SOMB PDF — no fabricated modifiers, no invented fees, no third-party guesswork.
How to read this guide
The Alberta Schedule of Medical Benefits is a large document, and much of it doesn't apply to general practice. This guide intentionally narrows in on the subset of codes family physicians actually use: in-office assessments, in-office consultations, phone and video encounters, home and hospital visits, and the small set of minor procedures most commonly billed from a family practice exam room.
Every code card below lists the exact SOMB description, the current 2026 fee, and the documentation the code requires. We have deliberately left out codes we cannot verify against the SOMB PDF — if you've seen a code on another site or in older software that isn't listed here, double-check it against the current Schedule before billing.
For a structured, searchable view of the same data, see the SOMB 2026 Fee Schedule reference page.
Verified SOMB 2026 codes for family practice
Limited assessment of a patient's condition requiring a history related to the presenting problems, an examination of the relevant body parts or systems, and appropriate records. This is the baseline in-office visit code for focused encounters.
Chief complaint, focused history, relevant physical exam findings, assessment, and management plan for the presenting problem(s).
Comprehensive assessment of a patient's condition requiring a complete history, a complete physical examination, and a written record. Scope — not time alone — determines whether this code is appropriate.
Do not bill 03.04A in place of 03.03A simply because a focused visit ran long. Audits look for a documented complete history and complete physical exam.
Complete history (HPI, past medical, family, social, medications, allergies, review of systems) and a complete physical examination by system, with written assessment and plan.
Minor consultation provided in the office at the request of another physician. Requires a documented referral and a written report back to the referring physician.
Missing referral source or absent written report back are the two most common reasons consultation codes get downgraded to visit codes on audit.
Name of referring physician, reason for referral, your assessment, and a copy of the written report sent back to the referring physician.
Comprehensive consultation in office at the request of another physician, requiring a complete history, complete physical examination, written opinion, and written report back to the referring physician.
Documented referral request, complete history and physical exam (as in 03.04A), written consultation opinion, and formal report returned to the referring physician.
Assessment of a patient's condition via telephone or secure videoconference. Same scope and fee as the in-office limited assessment (03.03A), but delivered virtually.
Modality (phone or video), duration, clinical content of the assessment, and plan. Secure platform must be used for video encounters.
Advice to a patient or their agent (as defined in the Personal Directives Act) via telephone, secure email, or videoconference. Lower-value than a full assessment.
Use 03.03CV (not 03.01AD) when the encounter is a true assessment. Use 03.01AD only for brief advice that does not rise to the level of an assessment.
Date, modality, advice provided, and any follow-up arranged.
Intramuscular or subcutaneous injection. Billable in addition to an assessment code when clinically indicated and properly documented.
Medication administered, dose, route, site, and indication.
Non-surgical treatment (cryotherapy, chemotherapy) of warts or keratoses. A common minor procedure performed during family practice visits.
Lesion site(s), number of lesions treated, method (e.g. liquid nitrogen), and patient tolerance.
Documentation habits that keep claims clean
03.04A requires a complete history and complete physical examination. A focused visit that ran long is still 03.03A. When Alberta Health audits a comprehensive assessment, they look for documented scope — review of systems, full exam by system — not visit duration.
03.07A and 03.08A both require a documented referring physician and a written report returned to that physician. Missing either element is the fastest route to a consultation code being downgraded to a visit code on audit.
03.03CV is an assessment by phone or secure video. 03.01AD is advice by phone, secure email, or video. 03.05JR is a physician phone call to discuss management or test results. These are not interchangeable — choose the code that matches the actual service.
For 13.59A, 98.12L, and other minor procedures, the chart needs procedure-specific detail: site, method, medication, lesion count. A single line saying "injection given" or "cryo performed" is not enough to survive an audit.
Third-party blogs, legacy billing templates, and word-of-mouth are a common source of fabricated or obsolete codes. The Alberta Health SOMB PDF is the only authoritative source. When in doubt, verify before billing.
Example: office visit with minor procedure
A patient presents in office for a focused visit to discuss a new plantar wart. You take a focused history, examine the foot, and treat the lesion with liquid nitrogen cryotherapy. Your chart documents the assessment, the procedure site, method, lesion count, and patient tolerance.
Note: this example shows a valid two-code encounter. It is not a claim that every visit can support two codes — only bill the codes your documentation supports.
Frequently Asked Questions
What's the difference between 03.03A and 03.04A?
03.03A ($40.23) is a limited assessment — the standard code for a focused visit addressing one or a small number of presenting problems, with a history and examination related to those problems. 03.04A ($110.64) is a comprehensive assessment — it requires a complete history, complete physical examination, and a written record of findings. You cannot simply bill 03.04A because a visit ran long; the comprehensive scope and documentation have to support it. When in doubt, bill 03.03A and document thoroughly.
When should I bill 03.07A versus 03.08A?
Both are in-office consultation codes, and both require a documented referral from another physician plus a written report back. 03.07A ($70.39) is a minor consultation. 03.08A ($131.40) is a comprehensive consultation and requires the same complete history and complete physical exam scope as 03.04A. Without a valid referral source in your chart and a report back to the referring physician, neither code is billable — Alberta Health will downgrade or deny the claim.
How do phone and video visits get billed in Alberta SOMB 2026?
03.03CV ($40.23) is the assessment code for a patient encounter conducted by telephone or secure videoconference — it mirrors 03.03A in scope and fee. 03.01AD ($20.00) is a separate, lower-value code for advice to a patient or their agent via telephone, secure email, or videoconference. 03.05JR ($20.00) covers a physician telephone call directly to a patient to discuss management or diagnostic test results. Pick the code based on the actual service delivered — an assessment is not the same as brief advice.
Can I bill a procedure code on the same day as an office visit?
Yes — SOMB permits billing an assessment code together with a minor procedure code when both services are clinically indicated and documented. For example, seeing a patient for a focused assessment (03.03A) and also performing cryotherapy of a wart (98.12L, $13.84) is a valid two-code encounter, provided your note documents the assessment separately from the procedure details (site, method, lesion count). Do not bill a procedure code alone when the visit also included a substantive assessment.
Where can I verify the exact fee for an Alberta billing code?
The authoritative source is the Alberta Health Schedule of Medical Benefits (SOMB) PDF, updated periodically by the Ministry of Health. Every code and fee in this guide is taken directly from the SOMB 2026 PDF — not from third-party summaries. If a number on a billing blog or software tool doesn't match the SOMB PDF, trust the PDF. RevNote AI's billing engine validates every suggested code against the current SOMB PDF to avoid drift and fabricated codes.
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