Every Alberta physician bills through the Schedule of Medical Benefits (SOMB), but few have time to learn the full structure.
This guide covers how Alberta billing codes work, how the fee schedule is organized, and what you need to know to bill accurately and defensibly.
The Schedule of Medical Benefits (SOMB) is Alberta's official fee schedule for physician services. It defines every billable medical service, its associated code, the base fee, and the rules governing when and how each code can be billed. The SOMB is maintained by Alberta Health and updated periodically.
Each SOMB code consists of a numeric code with an alphabetic suffix (e.g., 03.04A, 13.99B). The code structure encodes information about the service category:
These cover office visits, hospital visits, consultations, and assessments. The fee varies significantly based on whether the encounter is a consultation or a follow-up visit, and the setting (office, hospital, ER, home).
Procedural codes cover everything from minor office procedures to complex surgical operations. Many procedures have associated companion codes for related services (e.g., tray fees, anaesthesia, aftercare).
Surgical procedures are organized by anatomical region and complexity. When multiple procedures are performed in the same session, GR 6.9.7 rules govern fee adjustments on secondary procedures.
Anaesthesia has its own fee structure based on base units plus time units. Anaesthesia billing follows specific rules that differ from other specialties.
Alberta SOMB includes 10 modifier types that adjust the base fee for specific circumstances. These include after-hours premiums, complexity modifiers, bilateral procedure modifiers, and more. See the full modifiers reference for details.
The SOMB includes 18 governing rules that override or supplement code-specific rules. The most impactful for day-to-day billing include:
Even experienced Alberta physicians face recurring challenges with SOMB billing: