Billing Codes and Payment Schedule

Payments for Midwifery services are made through the MSP claims submission and processing system - usually electronically via Teleplan. Midwifery services provided to MSP beneficiaries, when they are out of the province, are not a benefit under the Medical Services Plan.

Midwifery Payment Schedule: Midwifery Services

Preamble

The Midwifery Payment Schedule, which confirms the financial arrangement set out in the Midwifery Master Agreement, will identify the terms and conditions of payments to Midwives for Midwifery Services rendered.

This Payment Schedule is based on a payment model that provides payment for all Midwifery Services rendered to an Eligible Client in each of the five phases of a Full Course of Care from conception up to and including six weeks post-partum. Payment is made subject to the terms of the Medicare Protection Act. Midwifery is commonly a shared practice so that more than one Midwife can deliver services to an Eligible Client. Only Midwives subject to the Midwifery Master Agreement (“Master Agreement”) can be paid under the Master Agreement and the Midwifery Payment Schedule. The Midwifery Payment Schedule is intended to be consistent with all terms and conditions established under the Master Agreement.

Only one Midwife may bill MSP for the service in accordance with the payment schedule.

A. Terms and Definitions

1. In this Payment Schedule:

(a) “Agreement” or “Master Agreement” means the Midwifery Master Agreement negotiated between the Government and the MABC for the period April 1, 2012 to March 31, 2014.

(b) “Attending Midwife” means the Midwife in attendance at the birth and who provides Midwifery Services within her scope of practice.

(c) “College of Midwives of BC” or “CMBC” or “College” means the regulatory body for the profession of Midwifery as established under the Health Professions Act [RSBC 1996] Chapter 183.

(d) “Conditional Registrant” means a Midwife designated as a conditional registrant by the CMBC and supervised by the Principal Supervisor and other supervisors as approved by the CMBC.

(e) “Consultative Care”, as distinguished from Transfer of Care, means collaboration by referral to a physician in order to request a medical consult, a laboratory procedure or other diagnostic test, or specific surgical/medical treatment. Primary care of the client and responsibility for decision making, with the informed consent of the client, remains with the Midwife within her scope of practice.

(f) “Dispute” means a difference over the interpretation, application or operation of this Payment Schedule as described in section 11.

(g) “Eligible Client” means a resident of British Columbia who is a beneficiary under the Medical Services Plan (MSP) and enrolled in the MSP in accordance with Section 7 of the Medicare Protection Act [RSBC 1996] Ch. 286 [hereinafter Medicare Protection Act].

(h) “Eligible Practitioner” means a Midwife enrolled in MSP in accordance with Section 13 of the Medicare Protection Act.

(i) “Full Course of Care” or “FCC” means primary care provided by a Midwife for an Eligible Client during pregnancy, labour and delivery, up to and including six (6) weeks post partum and care of the newborn for up to and including six (6) weeks after birth within the scope of practice of the Midwife as established by the College.

(j) “Hard Opt Out” refers to the situation in which an Enrolled Midwife elects to collect the MSP fee in full directly from an Eligible Client according to the Midwifery Payment Schedule for services to Eligible Clients. Eligible Clients are entitled to reimbursement from MSP for the MSP Payment. Election for payment is laid out under Section 14 of the Medicare Protection Act.

(k) “Health Insurance BC” or “HIBC” is the agent of Government for processing of claims to the Medical Services Plan and issuing payment for Midwifery Services.

(l) “Home Birth” For the purposes of this Payment Schedule and Fee Items 36045, 36046 and 36047, “Home Birth” refers to those situations where an eligible client births outside of a hospital setting and a midwife has provided care within her scope of practice, or when an eligible client plans to birth at home, has been attended at home by a Registered Midwife who provided care within her scope of practice during the intrapartum period, and births in hospital.

(m) “Locum” means an enrolled Midwife to whom care of the Eligible Clients is temporarily transferred by the Midwife who retains the Locum for a specific period of time. The Locum may assign payment to the payee of her choice.

(n) “Midwife” means a general, temporary or conditional registrant of the College whose membership is in good standing with the College.

[...continuation of Midwifery Payment Schedule - Preamble (PDF, 374KB)]