Updated April 1, 2026 — SOMB 2026 Effective

Alberta SOMB 2026
Fee Schedule

The most physician-friendly Alberta SOMB 2026 reference. Every family medicine billing code with fees, eligibility rules, frequency limits, and audit documentation requirements — organized for how GPs actually work.

Quick Stats — SOMB 2026

Verified codes in this guide27
SOMB effective dateApr 1, 2026
Verification methodPDF-anchored
Claim submission limit6 months
Audit lookback period3–5 years

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SOMB 2026 — Effective April 1, 2026

Alberta Health updated the SOMB effective April 1, 2026. Every code and fee on this page is verified against the current SOMB PDF. Always verify current fees at alberta.ca/schedule-of-medical-benefits.

Office Visits & Assessments

PDF-verified SOMB 2026 assessment codes used in general practice

03.03A

Limited assessment of a patient's condition (in-office visit)

Per encounter

Baseline limited assessment — history related to presenting problem(s), directed examination, appropriate advice. Used for most routine GP visits.

Audit doc: Document presenting complaint, directed findings, assessment, and plan.

$40.23
03.04A

Comprehensive assessment — in office

Per eligible encounter

Complete history and complete physical examination. Use when documentation actually supports a full comprehensive workup — not for routine follow-ups.

Audit doc: Note must show complete history and complete multi-system physical exam.

$110.64
03.07A

Minor consultation — in office

Per consultation

In-office consultation at the request of another physician (lower complexity than 03.08A).

Audit doc: Referral source and written/electronic consult report required.

$70.39
03.08A

Comprehensive consultation — in office

Per consultation

Comprehensive in-office consultation at the request of another physician.

Audit doc: Referral source, complete history & exam, and written consult report required.

$131.40
03.03D

Hospital visit

Per hospital encounter

In-hospital attendance on an admitted patient.

Audit doc: Document date, findings, assessment, and management.

$43.50
03.03N

Home visit — first patient

Per home visit

First patient seen during a home visit.

Audit doc: Document location and clinical reason a home visit was required.

$90.51
03.03P

Home visit — second/subsequent patients (same location)

Per additional patient

Second and subsequent patients seen at the same home-visit location.

Audit doc: Document link to the first-patient home visit and each additional encounter.

$40.23

Prenatal Visits

Prenatal-only assessment codes — do not use for general care

03.04B

Initial prenatal visit — complete history and physical

Once per pregnancy

Initial prenatal visit requiring complete history and physical exam. Prenatal-only — not interchangeable with 03.04A.

Audit doc: Chart must establish prenatal context and a full initial obstetric workup.

$110.62
03.03B

Prenatal visit — in office (follow-up)

Per prenatal visit

In-office prenatal follow-up visit. Strictly prenatal — cannot substitute for a regular 03.03A.

Audit doc: Document gestational age, relevant prenatal findings, and plan.

$38.99

Phone & Video Care

Verified remote-care codes — strict documentation requirements

03.03CV

Assessment via telephone or secure videoconference

Per encounter

Full assessment conducted by phone or secure video. Substantive clinical work required — not for booking, results-only, or admin calls.

Audit doc: Document modality (phone vs. video platform), start/end time, history, assessment, and plan.

$40.23
03.05JR

Physician telephone call to patient — results / management

Per call (restrictions apply)

Physician-initiated call directly to patient to discuss test results or management. Subject to SOMB frequency and eligibility rules.

Audit doc: Document who was called, the clinical content, and the decision or plan communicated.

$20.00
03.01AD

Advice to patient (or agent) via telephone

Per call (restrictions apply)

Telephone advice to a patient or their agent as defined in the Personal Directives Act. Read the full SOMB rule before billing.

Audit doc: Document identity of caller, clinical issue, advice given, and follow-up plan.

$20.00
03.05JB

Scheduled family conference — per 15 minutes

Per 15-min unit or major portion

Formal, scheduled family conference about a specific patient.

Audit doc: Document attendees, start/end time per unit, topics discussed, and decisions.

$54.97

Minor Procedures

Verified in-office procedure codes (13.x / 98.x series)

13.59A

Intramuscular or subcutaneous injection

Per injection

IM/SC injection — document substance administered, site, and indication.

Audit doc: Substance, dose, route, site, lot number (when applicable), and indication.

$10.73
98.03A

Incision and drainage of abscess or hematoma (subcutaneous/submucous)

Per procedure

Simple incision and drainage performed in office.

Audit doc: Document location, size, anesthetic used, and drainage findings.

$16.69
98.12A

Excisional biopsy, skin

Per lesion

Excisional biopsy of a skin lesion (non-facial).

Audit doc: Document lesion, technique, closure, and whether specimen was sent to pathology.

$44.39
98.12B

Excisional biopsy, skin of face

Per lesion

Excisional biopsy on the face (higher fee reflects complexity).

Audit doc: Document facial location, technique, closure, and pathology submission.

$56.93
98.12C

Removal of sebaceous cyst

Per cyst

Excision of a sebaceous cyst.

Audit doc: Document location, technique, and specimen handling.

$38.56
98.12H

Excision of subcutaneous soft-tissue tumor — per 30 min operating time

Per 30 min or major portion

Subcutaneous soft tissue tumor excision; time-based.

Audit doc: Document start/end time, technique, and specimen.

$96.09
98.12J

Removal or excision — first lesion

First lesion

Removal of first lesion (non-cryotherapy, non-fulguration method).

Audit doc: Document each lesion separately with location and method.

$19.23
98.12K

Removal by fulguration — first lesion

First lesion

Fulguration removal of first lesion.

Audit doc: Document technique, location, and each subsequent lesion separately.

$24.85
98.12L

Non-surgical treatment — cryotherapy/chemotherapy for warts or keratoses

Per session

Cryotherapy or topical chemotherapy for warts or keratoses. Commonly under-billed when done alongside a 03.03A visit.

Audit doc: Document lesion(s) treated, method (e.g., liquid nitrogen), and response plan.

$13.84
98.12Q

Removal of atypical or neoplastic lesion(s) — any method (excluding cryotherapy for actinic keratosis)

Per lesion

Atypical/neoplastic lesion removal.

Audit doc: Document clinical suspicion, method, and pathology submission.

$38.94

PCPCM — Primary Care Panel-Based Payment

Blended-payment tracking codes under the PCPCM Operations Manual (separate from fee-for-service)

PC001

Business-hours direct care

Per 15 minutes

PCPCM direct-care time code (business hours). Not a fee-for-service billing code — usage is governed by the PCPCM Operations Manual. Daily volume cap applies.

Audit doc: Submit with PCPCM BA, correct ULI, and diagnostic code per the current PCPCM Operations Manual.

$26.25
PC002

Indirect care (any hours)

Per 15 minutes

PCPCM indirect-care time code. Consult the PCPCM Operations Manual for eligibility and daily caps.

Audit doc: Document the indirect-care activity per PCPCM rules and submit with PCPCM BA.

$26.25
PC003

After-hours weekday direct care

Per 15 minutes

PCPCM after-hours weekday direct-care time code. Subject to the 20% after-hours cap per fiscal year.

Audit doc: Confirm timing, daily cap, and fiscal-year after-hours cap per PCPCM Operations Manual.

$48.18
PC004

After-hours weekend / statutory holiday direct care

Per 15 minutes

PCPCM weekend/holiday direct-care time code. Subject to the 20% after-hours cap per fiscal year.

Audit doc: Confirm timing, daily cap, and fiscal-year after-hours cap per PCPCM Operations Manual.

$48.18

Common AHCIP Rejection Codes

Most frequent claim denials and how to fix them

CodeMeaningFix
15Duplicate ClaimCheck remittance advice — same code billed twice. Review billing software for double submissions.
18Service Not CoveredCode not covered for the patient's age, sex, or health card category. Verify eligibility before billing.
21Co-billing RestrictionTwo codes billed together that AHCIP won't pay simultaneously. Remove lower-value code or rebill on different date.
31Frequency ExceededCode billed more times than the SOMB rule allows for that patient or time window. Review the code's frequency limit in the current SOMB PDF before resubmitting.
46Time Limit ExceededClaim submitted too late (>6 months from service date). Submit all claims within 90 days to avoid this.
56Documentation RequiredAlberta Health flagged claim for insufficient documentation. Submit supporting chart notes via AHCIP portal.
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