How to Bill Telephone Follow-Ups
in Alberta (2026) — Verified Guide
Alberta SOMB 2026 has a clear set of codes for telephone encounters. The hard part is picking the correct tier — brief advice, a full focused assessment, a physician-initiated call, or a structured conference. This guide walks through each, using only PDF-verified SOMB 2026 codes.
When Does a Phone Call Become a Billable Encounter?
Not every phone call is billable. Alberta Health generally requires all three conditions below for a telephone encounter to qualify:
The call involves genuine clinical content — conveying a clinically meaningful result, answering a clinical question, providing advice, or performing a focused assessment. Pure scheduling and administrative calls do not qualify.
The patient is an established patient for the condition being discussed. Cold calls from patients you've never seen do not qualify as billable encounters.
A clinical note is entered in the chart with date, start time, mode, content, and the clinical decision made.
Verified Telephone Codes — Alberta SOMB 2026
Short, discrete communications — conveying a lab result, answering a single clinical question, authorizing a refill. No full assessment is performed.
Not appropriate when the encounter involved history taking and clinical decision-making at the level of an office assessment. In that case, use 03.03CV.
Date, start time, mode (phone / email / video), content of the advice, clinical rationale.
The patient is an established patient. The encounter includes a focused history, clinical assessment, and a management plan — equivalent in scope to an office-based limited assessment.
Cannot be billed when the call is a brief result-communication or a refill request — those are 03.01AD. Must not double-bill with an in-person visit on the same problem, same day.
Date, start/end time, duration, mode, presenting concern, history obtained, assessment, plan, any prescriptions or referrals.
The physician initiates a phone call to the patient — typically to follow up on a result, a prescription change, or a safety check. Distinct from a scheduled appointment.
Read the SOMB 2026 notes for 03.05JR carefully — scope and co-billing with 03.01AD/03.03CV are defined in the PDF.
Date, start time, reason for the call, content, outcome, any follow-up arranged.
A scheduled, structured conference with the patient and/or family members to discuss complex care decisions, goals of care, or end-of-life planning. May be in person, by phone, or by video.
Time-based: each 15-minute unit is a separate fee. Follow SOMB 2026 rounding rules and the definition of a qualifying conference.
Participants (patient, family, relationship), topics discussed, decisions made, start and end time, total duration in minutes.
Worked Examples — Picking the Right Code
Same patient, four different phone interactions. Each maps to a different verified SOMB code:
Monday — patient calls to ask about a lab result. You confirm TSH is normal, brief reassurance. 3 minutes.
Tuesday — you call the patient to inform them their INR is 4.8 and to hold warfarin for 2 days. Brief physician-initiated safety call.
Wednesday — 16-minute video visit for new URTI symptoms. Focused history, red-flag review, management plan, prescription sent.
Friday — 30-minute phone conference with patient and adult son to discuss advance care planning. Two 15-minute units.
Fees from Alberta SOMB 2026 (effective April 1, 2026). Subject to SOMB rules, limits, and any applicable co-billing restrictions.
Frequently Asked Questions
Can I bill a telephone visit the same day as an in-person office visit?
Generally no — if you saw the patient in person the same day, a subsequent phone call is typically considered follow-up to that visit and not separately billable. Exceptions may exist if the phone call addresses a distinctly different clinical problem that arose independently later in the day. Consult the current SOMB notes before double-billing.
Do I need patient consent to bill a phone call as a medical encounter?
Alberta Health does not require explicit written consent for telephone encounters, but CPSA has guidance on telehealth consent. Best practice is verbal consent documented in your note: 'Patient consented to telephone consultation.'
What if the patient calls me but I call them back — does that qualify?
Yes. Whether the call originates from the patient or the physician, if a clinical assessment and management decision occurs, it qualifies as a billable encounter. The initiator of the call does not determine billability — the clinical content does. Note that 03.05JR specifically contemplates physician-initiated calls.
How do I choose between 03.01AD and 03.03CV?
03.01AD ($20.00) is for brief advice — a single-issue interaction like 'your TSH is normal, continue current dose'. 03.03CV ($40.23) is for a full focused assessment by phone or video — a history, clinical reasoning, and a management plan. Match the code to the clinical work actually performed, not to convenience.
How does Alberta Health verify that a phone call qualifies as a billable encounter?
Alberta Health does not pre-screen telephone claims differently from in-person claims. However, in audit reviews, they will request your clinical documentation to verify the clinical content justified the billed service. Poor or missing documentation for phone encounters is a common audit finding.
Related Billing Guides
Pick the Right Phone Code, Every Time
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