Virtual care billing in Alberta — telehealth codes and rules

Alberta SOMB provides billing pathways for telephone and video consultations, but the rules have changed significantly since 2020 and many physicians are billing these incorrectly or not at all.

This page covers the applicable SOMB codes, modifier requirements, and documentation expectations for virtual care encounters in Alberta.

Phone vs. video: the billing distinction

Alberta SOMB distinguishes between telephone visits and video visits. They do not share the same codes, and the documentation requirements differ:

Key virtual care SOMB codes for GPs

The most commonly used virtual care codes for general practitioners in Alberta include telephone management codes and virtual office visit equivalents. The applicable code depends on:

• Whether the patient is established or new
• Duration of the encounter
• Clinical complexity (straightforward vs. complex)
• Whether the visit substitutes for an in-person encounter

Telephone management codes typically require the visit to be initiated by a physician and involve a clinical assessment — not just administrative tasks like booking or refill requests without clinical discussion.

Modifier requirements for virtual care

Alberta uses a telehealth modifier system to flag virtual encounters. The correct modifier depends on your practice setting and the nature of the encounter:

• Telephone encounters — require documentation that a telephone encounter occurred, not an in-person visit
• Video encounters — some are billable using the equivalent in-person codes with a telehealth modifier indicating synchronous video
• Rural and remote settings — additional modifiers may apply for physicians serving patients in rural Alberta via telehealth

Common virtual care billing mistakes

1. Billing telephone visits with in-person codes

Using a standard office visit code (like a GP office visit) without the appropriate telehealth modifier misrepresents the service. AHCIP may flag or reject claims where the service location does not match the billing code.

2. Billing asynchronous communication as a visit

Responding to a patient's portal message or email — even if clinically substantive — is generally not billable as a telephone or video visit under SOMB. A billable telephone visit requires real-time two-way communication.

3. Not documenting the virtual nature of the encounter

Chart notes for virtual visits should explicitly state: the modality (phone or video), who initiated the call, the patient's location, and that valid consent for virtual care was obtained. Missing documentation is the primary reason virtual care claims are reversed on audit.

4. Treating telephone triage as a billable telephone visit

Brief triage calls — typically under 5 minutes and focused on routing the patient to the right care setting — do not meet the threshold for a telephone management visit. The call must involve clinical assessment and management.

Documentation standards for virtual visits

For every virtual care encounter, your chart note should include:

• Date and time of the encounter
• Modality (telephone or video)
• Duration (where relevant for time-based codes)
• Patient's location at time of call
• That the patient consented to virtual care
• Clinical assessment, plan, and any follow-up