Preventive Care Billing in Alberta
— Annual Health Reviews and Screening Codes (2026)
Alberta family physicians are leaving significant revenue on the table during preventive care visits. With the 2026 SOMB updates, a comprehensive annual health review now pays $113.74 for adults and $139.16 for seniors 75+, yet over half of GPs performing these assessments fail to bill the appropriate codes, defaulting instead to lower-paying visit codes or failing to capture preventive counselling add-ons worth an additional $28.50.
Understanding Alberta's Preventive Care Billing Framework
Preventive care billing in Alberta has evolved significantly with the 2026 SOMB updates, creating distinct fee codes that recognize the time and complexity involved in comprehensive health assessments versus acute care visits. The cornerstone codes — 03.07A for adults 18–74 and 03.07D for seniors 75+ — are designed to compensate physicians for thorough preventive assessments that include comprehensive history-taking, systems review, complete physical examination, age-appropriate screening discussions, and risk factor counselling.
The critical distinction Alberta Health makes is between preventive visits (which are planned, comprehensive, and focused on wellness and risk reduction) and acute visits (which address specific symptoms or problems). This distinction isn't merely semantic — it determines which codes you can legitimately bill and whether your claims will withstand audit scrutiny. Many GPs mistakenly bill a standard office visit code when a patient comes in "for their physical," leaving $50–80 on the table per encounter.
The 2026 fee schedule also introduced the 03.05N preventive counselling add-on, which recognizes that structured behaviour change counselling — whether for smoking cessation, weight management, or alcohol reduction — requires dedicated time beyond the base assessment. This add-on can be billed once per preventive encounter when you provide structured, documented counselling that goes beyond brief advice. Understanding when and how to appropriately combine these codes is essential for accurate billing that reflects the actual clinical work performed.
Billing Codes That Apply
Comprehensive preventive health assessment for patients 18–74. Includes history, physical, risk factor screening, and preventive counselling. Once per calendar year per patient.
Once per year. Cannot be billed on same day as an acute visit for the same patient (different clinical purpose required).
Full history, systems review, physical findings, preventive screening results, risk counselling documented.
Comprehensive preventive assessment for patients 75 and older. Higher fee reflects increased complexity and time required for geriatric assessment.
Once per year. Must be comprehensive — not a focused acute visit repackaged.
Fall risk, cognitive screen, ADLs, medications reviewed, full physical, preventive counselling.
Structured preventive counselling (smoking cessation, weight management, alcohol reduction) provided as distinct component of preventive visit.
Once per encounter. Must be structured counselling — not incidental mention.
Topic, approach used, patient response, follow-up plan.
Common Documentation Mistakes That Trigger Claim Denials
Auditors look for evidence of comprehensive assessment. If your chart note only addresses "patient here for prescription refill and also wanted blood pressure checked," you haven't performed or documented a comprehensive annual health review. The correct approach: ensure your documentation includes all required elements (full history update, complete systems review, comprehensive physical examination, screening discussion, and preventive counselling) before billing the preventive codes.
The higher fee for seniors requires enhanced documentation. Simply performing the same assessment you'd do for a 50-year-old won't support the 03.07D code. You must document geriatric-specific elements: fall risk assessment (balance, gait, home hazards), cognitive screening (MoCA, Mini-Cog), functional status (ADLs/IADLs), medication review for polypharmacy and inappropriate prescribing, and age-appropriate preventive screening discussions.
Writing "advised patient to quit smoking" or "discussed weight loss" doesn't support the preventive counselling add-on. For 03.05N to be defensible, document: the specific topic addressed, the counselling approach or framework used (e.g., 5 A's for smoking, motivational interviewing for alcohol), the patient's response and readiness to change, specific goals or action steps agreed upon, and your follow-up plan. This typically requires 5–10 minutes of dedicated counselling time.
Alberta Health views same-day preventive and acute visits with scrutiny unless there's clear documentation of two distinct clinical purposes requiring separate encounters. If a patient comes for their annual review and mentions new knee pain, you have two options: address only the preventive visit today and book a separate appointment for the knee, or address both but bill only the higher-value code (usually the preventive one) and document the acute issue was addressed opportunistically.
These codes are limited to once per calendar year, not once per 365 days. If you performed an annual review in December 2025, you can legitimately bill another in January 2026. However, billing in March 2026 and again in November 2026 will trigger an automatic rejection. Track your patients' last preventive visit dates and schedule annual reviews strategically to maximize compliance while optimizing revenue across calendar years.
Real Example: Maximum Revenue Scenario
68-year-old male presenting for annual health review. Patient has hypertension and type 2 diabetes (both stable), BMI 32, current smoker (15 cigarettes/day). Physician performs comprehensive history, complete physical examination, reviews lab results, discusses age-appropriate cancer screening, and provides structured smoking cessation counselling using the 5 A's approach with discussion of pharmacotherapy options.
Frequently Asked Questions
Can I bill 03.07A if I saw the patient 10 months ago for an acute visit and they're now coming specifically for their annual review?
Yes, absolutely. The key is that the preventive visit (03.07A) is a separate, distinct encounter with a different clinical purpose than your previous acute care visit. As long as you're performing and documenting a comprehensive preventive assessment and it's been at least one calendar year since their last annual review, the code is appropriate regardless of how recently you saw them for unrelated acute issues.
For 03.07D billing, do I need to use specific cognitive screening tools like MoCA, or can I document "cognitively intact" based on my clinical impression?
While Alberta Health doesn't mandate specific tools, audit-proof documentation for the $139.16 senior assessment requires objective evidence of cognitive evaluation. A brief validated tool (Mini-Cog takes 3 minutes, MoCA is more comprehensive) provides defensible documentation. Simply writing "cognitively intact" without documented assessment may not withstand scrutiny if your claim is audited, particularly given the premium fee for 03.07D reflects the expectation of formal geriatric assessment components.
If I provide 20 minutes of diet and exercise counselling for obesity during an annual review, can I bill both 03.07A and 03.05N, or is that considered part of the base preventive visit?
Yes, you can bill both. The 03.07A ($113.74) covers the comprehensive assessment including discussion of weight as a risk factor, but 03.05N ($28.50) is specifically designed to recognize structured behaviour change counselling that goes beyond routine discussion. Document your counselling approach (e.g., motivational interviewing, SMART goal setting), specific dietary and activity recommendations, barriers identified, and follow-up plan. This combination totals $142.24 for a well-documented preventive visit with obesity counselling.
A patient comes in December 2025 for their annual review. Can I see them again in January 2026 and bill 03.07A again since it's a new calendar year?
Technically yes, the code restriction is "once per calendar year," so billing in December 2025 and January 2026 doesn't violate the frequency limit. However, this practice raises audit flags. You must have legitimate clinical justification for comprehensive preventive assessments one month apart, and your documentation must support that both encounters were medically necessary comprehensive reviews, not one visit split into two for billing purposes. Most appropriate use: patient missed their 2025 review, came in December, and you schedule their next review for December 2026.
What's the difference between billing 03.07A versus just billing a longer office visit code when doing a physical exam?
The difference is both clinical intent and compensation. 03.07A ($113.74) is specifically for planned, comprehensive preventive assessments focused on health maintenance and disease prevention in asymptomatic patients. A longer office visit code (even a comprehensive assessment code) typically pays $40–75 and is intended for problem-focused encounters. If the patient books specifically for "my annual physical" and you perform comprehensive preventive care, 03.07A is the appropriate code and pays significantly better. Using visit codes for preventive work systematically undervalues your time and leaves substantial revenue uncaptured.
Related Billing Guides
Stop Leaving Preventive Care Revenue Uncaptured
RevNote AI automatically identifies when your clinical documentation supports 03.07A, 03.07D, or 03.05N billing, ensuring you capture the full value of comprehensive preventive visits. Our AI analyzes your notes in real-time, flags missing documentation elements for premium codes, and suggests appropriate billing combinations based on 2026 SOMB rules. Try it free for your next 10 encounters and see how much preventive care revenue you've been missing.
No credit card. Works in 60 seconds.