Essential Fee Codes — Quick Reference
These 8 codes form the billing backbone for most Alberta family physicians. Mastering when and how to apply each one is the single highest-ROI billing activity.
| Code | Service | Fee (2026) |
|---|---|---|
| 03.03A | Limited Assessment — in office | $40.23 |
| 03.04A | Comprehensive Assessment | $110.64 |
| 03.07A | Minor Consultation — in office | $70.39 |
| 03.08A | Comprehensive Consultation | $131.40 |
| 03.03CV | Phone / Video Assessment | $40.23 |
| 03.05JR | Physician Phone Call to Patient | $20.00 |
| 03.03D | Hospital Visit | $43.50 |
| 13.59A | IM/SC Injection | $10.73 |
Source: Alberta Schedule of Medical Benefits (SOMB) 2026, effective April 1, 2026. Full fee schedule → · Billing codes deep dive →
How Alberta Physician Billing Works
The AHCIP System
All Alberta physicians bill the Alberta Health Care Insurance Plan (AHCIP). Unlike private insurance, AHCIP reimburses based on the Schedule of Medical Benefits (SOMB) — a comprehensive fee schedule updated April 1 annually. There is no prior authorization required for most services, but documentation must support every code you bill.
The SOMB Structure
The SOMB organizes codes by specialty and service type. For family physicians, the key sections are: Section 1 (Visits & Consultations, codes 03.xx), Section 2 (Diagnostic & Therapeutic Procedures), and various premium codes layered on top of base visit codes. Most GPs default to 03.03A when more complex codes often apply.
Billing vs. Revenue
Submitting a claim is not the same as receiving payment. Claims can be denied, reduced, or queried. Common rejection codes include incorrect patient info, co-billing violations, frequency limit breaches, and insufficient documentation. Understanding rejection patterns is as important as knowing which codes to bill.
Premium & Modifier Strategy
Alberta billing's real opportunity is choosing the visit code that actually matches what you documented — and adding the procedure and contact codes your note supports. A comprehensive assessment (03.04A, $110.64) is nearly 2.75× a limited visit (03.03A, $40.23); a documented IM injection (13.59A, $10.73) or wart cryotherapy (98.12L, $13.84) is a separate line. Many GPs default to 03.03A out of habit.
In-Depth Billing Guides
Each guide covers eligibility, documentation requirements, common mistakes, and worked examples for that billing scenario.
How to Bill Telephone Follow-Ups in Alberta
Codes 03.03CV (phone/video assessment) and 03.05JR (physician phone call to patient) explained — how to document clinical telephone management correctly.
Telehealth Billing Codes Alberta 2026
Complete guide to virtual visit billing codes, video consult premiums, and when Alberta Health reimburses remote care.
Billing a Procedure and Office Visit Same Day
SOMB rules on same-day billing combinations — which codes can co-exist and which trigger automatic denials.
Alberta Billing Rejection Codes Explained
Every major AHCIP rejection code decoded with the exact fix for each — stop resubmitting blind.
PCPCM vs Fee-for-Service Alberta 2026
Which contract model pays more? A complete financial comparison for Alberta family physicians.
How to Survive an AHCIP Billing Audit
What triggers audits, what auditors look for, and exactly how to prepare your documentation to emerge unscathed.
How RevNote AI Achieves 99% Billing Accuracy
A deep-dive into the Neuro-Symbolic billing engine that catches codes human reviewers miss — and why deterministic rule validation matters for audit safety.
Sessional vs Shadow Billing — Which Pays More?
A clear financial breakdown of sessional and shadow billing models for Alberta locums and hospital physicians.
WCB Billing Guide for Alberta Physicians
How to bill Workers' Compensation Board claims correctly — fee codes, forms, and common mistakes.
Frequently Asked Questions
What is the Schedule of Medical Benefits (SOMB) in Alberta?
The SOMB is the official fee schedule published by Alberta Health that defines every billable medical service and its reimbursement rate. Updated annually (effective April 1), it contains 400+ fee codes for physician services under AHCIP. For 2026, it includes updated rates for family medicine, specialist, and procedural codes.
How much money do Alberta GPs typically lose in missed billing?
The biggest recurring gap we see is defaulting to 03.03A (Limited Assessment, $40.23) when the note actually documents a comprehensive assessment (03.04A, $110.64) or a referral-based consultation (03.07A $70.39 / 03.08A $131.40). Missed minor procedures (98.12 series, 98.03A, 13.59A) and phone/video visits (03.03CV $40.23, 03.05JR $20.00) are the other frequent gaps. RevNote surfaces only codes supported by your own note — it does not guarantee a specific dollar recovery.
What triggers an AHCIP audit of physician billing?
Alberta Health monitors billing patterns statistically. Common triggers: billing rates for premium codes significantly above peer average, high volumes of time-based codes without supporting documentation, unusual code combinations, sudden billing spikes, and random sampling audits. The key protection is thorough, contemporaneous chart documentation.
Can Alberta GPs bill for telephone calls with patients?
Yes. Code 03.03CV ($40.23 GP) covers a clinical assessment delivered via telephone or secure video — the same fee as an in-office limited visit. Code 03.05JR ($20.00) covers a physician telephone call directly to the patient to discuss test results or management. Both require documentation of the clinical issue, assessment, and management plan. Administrative calls do not qualify.
What is the difference between sessional and fee-for-service billing in Alberta?
Fee-for-service (FFS) means you bill AHCIP directly for each encounter using SOMB codes. Sessional billing pays a flat hourly/session rate regardless of patients seen — common in hospital and ER settings. Shadow billing is a hybrid where you work sessionally but also shadow-bill AHCIP for tracking. The best model depends on your setting and patient volume.
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