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
Limited assessment of a patient's condition (in-office visit)
Per encounterBaseline 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.
Comprehensive assessment — in office
Per eligible encounterComplete 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.
Minor consultation — in office
Per consultationIn-office consultation at the request of another physician (lower complexity than 03.08A).
Audit doc: Referral source and written/electronic consult report required.
Comprehensive consultation — in office
Per consultationComprehensive in-office consultation at the request of another physician.
Audit doc: Referral source, complete history & exam, and written consult report required.
Hospital visit
Per hospital encounterIn-hospital attendance on an admitted patient.
Audit doc: Document date, findings, assessment, and management.
Home visit — first patient
Per home visitFirst patient seen during a home visit.
Audit doc: Document location and clinical reason a home visit was required.
Home visit — second/subsequent patients (same location)
Per additional patientSecond and subsequent patients seen at the same home-visit location.
Audit doc: Document link to the first-patient home visit and each additional encounter.
Prenatal Visits
Prenatal-only assessment codes — do not use for general care
Initial prenatal visit — complete history and physical
Once per pregnancyInitial 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.
Prenatal visit — in office (follow-up)
Per prenatal visitIn-office prenatal follow-up visit. Strictly prenatal — cannot substitute for a regular 03.03A.
Audit doc: Document gestational age, relevant prenatal findings, and plan.
Phone & Video Care
Verified remote-care codes — strict documentation requirements
Assessment via telephone or secure videoconference
Per encounterFull 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.
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.
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.
Scheduled family conference — per 15 minutes
Per 15-min unit or major portionFormal, scheduled family conference about a specific patient.
Audit doc: Document attendees, start/end time per unit, topics discussed, and decisions.
Minor Procedures
Verified in-office procedure codes (13.x / 98.x series)
Intramuscular or subcutaneous injection
Per injectionIM/SC injection — document substance administered, site, and indication.
Audit doc: Substance, dose, route, site, lot number (when applicable), and indication.
Incision and drainage of abscess or hematoma (subcutaneous/submucous)
Per procedureSimple incision and drainage performed in office.
Audit doc: Document location, size, anesthetic used, and drainage findings.
Excisional biopsy, skin
Per lesionExcisional biopsy of a skin lesion (non-facial).
Audit doc: Document lesion, technique, closure, and whether specimen was sent to pathology.
Excisional biopsy, skin of face
Per lesionExcisional biopsy on the face (higher fee reflects complexity).
Audit doc: Document facial location, technique, closure, and pathology submission.
Removal of sebaceous cyst
Per cystExcision of a sebaceous cyst.
Audit doc: Document location, technique, and specimen handling.
Excision of subcutaneous soft-tissue tumor — per 30 min operating time
Per 30 min or major portionSubcutaneous soft tissue tumor excision; time-based.
Audit doc: Document start/end time, technique, and specimen.
Removal or excision — first lesion
First lesionRemoval of first lesion (non-cryotherapy, non-fulguration method).
Audit doc: Document each lesion separately with location and method.
Removal by fulguration — first lesion
First lesionFulguration removal of first lesion.
Audit doc: Document technique, location, and each subsequent lesion separately.
Non-surgical treatment — cryotherapy/chemotherapy for warts or keratoses
Per sessionCryotherapy 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.
Removal of atypical or neoplastic lesion(s) — any method (excluding cryotherapy for actinic keratosis)
Per lesionAtypical/neoplastic lesion removal.
Audit doc: Document clinical suspicion, method, and pathology submission.
PCPCM — Primary Care Panel-Based Payment
Blended-payment tracking codes under the PCPCM Operations Manual (separate from fee-for-service)
Business-hours direct care
Per 15 minutesPCPCM 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.
Indirect care (any hours)
Per 15 minutesPCPCM 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.
After-hours weekday direct care
Per 15 minutesPCPCM 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.
After-hours weekend / statutory holiday direct care
Per 15 minutesPCPCM 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.
Common AHCIP Rejection Codes
Most frequent claim denials and how to fix them
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