Medical Services Plan (MSP) provides the following benefits

• medically-required services of a physician, or of a specialist (such as a surgeon, anesthetist or psychiatrist) when referred by a physician;
• maternity care by a physician or by a midwife;
• diagnostic services, including x-rays and laboratory services, provided at approved diagnostic facilities, when ordered by a registered physician, midwife, podiatrist, dental surgeon or oral surgeon;
• dental and oral surgery, when medically required to be performed in hospital (excluding restorative services, i.e.: fillings, caps, crowns, root canals, etc.)*;
• orthodontic services related to severe congenital facial abnormalities;
• medically required eye examinations provided by an ophthalmologist or optometrist; and
• surgical podiatry.

* The removal of healthy wisdom teeth, even if impacted, is not a benefit. Surgical removal of an impacted third molar (wisdom tooth) is an MSP insured service only when hospitalization is medically required, due to the extreme complexity of the extraction and where there is associated pathology.

MSP does not provide coverage for the following:

• routine physical examinations performed for reasons other than medical necessity;
• medical examinations, certificates or tests required for life insurance, a driver’s licence, school, immigration, employment, etc.;
• cosmetic surgery for the alteration of appearance;
• restorative or other dental work performed in a dental office;
• eyeglasses, hearing aids, and other equipment or appliances;
• the services of counsellors or psychologists;
• routine eye examinations for beneficiaries between the ages of 19 and 64; and
• chiropractic, physiotherapy, naturopathy, massage therapy, acupuncture, and non-surgical podiatry services for persons not receiving MSP premium assistance.

Medical and healthcare practitioners shall not bill MSP for those services. They should bill their patients directly.

Surgical podiatry services are a benefit for all MSP beneficiaries. However, surgical podiatrists are allowed to opted out of MSP Fee Schedule and charge their patients more. Patients receiving surgical podiatry services may be responsible for

• operating room or surgical suite fees
• surgical supplies and
• service charges over and above what is insured by MSP.

Opted-out practitioners must advise their patients, prior to the treatment being performed:

• that they have opted out
• how much is reimbursed by MSP and
• how much the patient will be paying in addition to the MSP fee.

Opted Out practitioners should charge the fee difference directly to the patients.

Each medical occupation bills MSP using the applicable MSC Payment Schedule fee items. The MSC fees are established through consultation between Medical Services Commission and the respective professional association. Billing MSP for services that are not on the MSP Fee Schedule or billing MSP for higher amounts is not permitted.

 

MSC Payment Schedule
Amendments to the MSC Payment Schedule

Claim Manager offers built-in, searchable, automatically updated catalogues of MSP Fee Schedules for each medical and healthcare occupation.

A healthcare practitioner is eligible to bill MSP if the practitioner

• is licensed by the College of Physicians and Surgeons of British Columbia (CPSBC),
• provides services listed in the MSC Payment Schedule and other payment schedules to eligible patients, and
• enrolled with MSP.

Enrolled physicians receive an MSP practitioner number (also known as MSP payment or MSP billing number), which is indicated in MSP claims in a field “treating practitioner”.

MSP enrollment status and the possession of an active MSP billing number are contingent upon the practitioner’s continued licensure by the  College of Physicians and Surgeons of British Columbia (CPSBC). Any change in licensure, such as the renewal of a temporary license or specialty, must be reported to MSP to avoid refusal of claims.

Each physician enrolled with MSP is assigned a billing number consisting of two numbers:

• a practitioner number, which identifies the practitioner rendering the service, and
• a payment number, which identifies the person to whom payment is to be made.

MSP practitioner and payment numbers are usually the same, unless a practitioner requests an additional MSP payment number.

If physicians want to make their clinic an MSP payee, a clinic can receive an MSP payment number, too.

In case of a change in address, telephone number, specialty or licence status, physicians should advise MSP. MSP requires accurate information to provide physicians with billing support and ensure their claims’ validity.

MSP Enrollment for the Patients

Under the Medical Protection Act, eligible residents of B.C. must enroll themselves and their dependents with Medical Services Plan (MSP). If your patients have questions about MSP enrollment eligibility, please refer them to the MSP eligibility and enrollment web page.

 BC Services Card

MSP enrollment is confirmed by issuing an applicant the BC Services Card (former BC CareCard). Being presented with the healthcare card is not enough to verify patient’s MSP enrollment because the patient may carry a prematurely expired MSP card. To verify the patient’s MSP eligibility on the date of service, practitioners need to make an eligibility inquiry to MSP.

There are four ways to check MSP status of the patients.

1. Request an instant MSP eligibility report in Claim Manager.
2. Call the automated Practitioner Information Line:
   • Victoria: (250) 952-3102 or (250) 383-1226
   • Vancouver: (604) 669-6667
   • Toll-free: 1 800 742-6165
3. Use MSP Web Access.
4. Fax a request on a coverage research form if the PHN is unknown:
   • fax: (250) 952-3101.

Notes:

1. The services are listed in an order of convenience.
2. The patient’s personal health number (PHN) must be provided for steps 1, 2 and 3.
3. MSP Teleplan registration is required for steps 1 and 3.
4. Practitioner Information Line is an automated service that handles coverage inquiries using an interactive voice response (IVR) system.

Providers of required medical services can request an instant MSP eligibility report in Claim Manager. They must bill MSP if the MSP eligibility report reads that the patient

• “Is Eligible for Medical Coverage Under MSP” on the date of service.

Index (PDF, 38KB)
001 – 139.9	Infection and Parasitic Diseases (PDF, 46KB)
140 – 239.9	Neoplasms (PDF, 41KB)
240 – 279.9	Endocrine, Nutritional and Metabolic Diseases and Immunity Disorders(PDF, 19KB)
280 – 289.9	Diseases of Blood and Blood Forming Organs (PDF, 10KB)
290 – 319	Mental Disorders (PDF, 15KB)
320 – 389.9	Diseases of Nervous System and Sense Organs (PDF, 52KB)
390 – 459.9	Diseases of the Circulatory System (PDF, 23KB)
460 – 519.9	Diseases of the Respiratory System (PDF, 16KB)
520 – 579.9	Diseases of the Digestive System (PDF, 24KB)
580 – 629.9	Diseases of the Genitourinary System (PDF, 26KB)
630 – 676.9	Complications of Pregnancy, Childbirth and the Puerperium (PDF, 30KB)
680 – 709.9	Diseases of the Skin and Subcutaneous Tissue (PDF, 13KB)
710 – 739.9	Diseases of the Musculoskeletal System and Connective Tissue (PDF, 25KB)
740 – 759.9	Congenital Anomalies (PDF, 208KB)
760 – 779.9	Certain Conditions Originating in the Perinatal Period (PDF, 201KB)
780 – 799.9	Symptoms, Signs and Ill-defined Conditions (PDF, 209KB)
800 – 999.9	Injury and Poisoning (PDF, 1.2MB)
V01 – V82.9	Supplementary Factors Influencing Health Status and Contact with Health Services (PDF, 47KB)

Additional Diagnostic Codes (PDF, 9KB)

The Rural Retention Program (RRP) provides fee-for-service and flat sum premiums for eligible physicians living and practicing in certain BC communities. This incentive pays doctors additional funds for providing services in eligible rural communities throughout BC.

Rural Retention Programs (RRP) Points

Use one of the following codes to indicate the where the services took place.


(A) Practitioner’s Office – In Community

(C) Residential Care/Assisted Living Residence

(D) Diagnostic Facility

(E) Hospital – Emergency Room (Unscheduled Patient)

(F) Private Medical / Surgical Facility

(G) Hospital – Day Care (Surgery)

(H) Hospital

(I) Hospital – Inpatient

(M) Mental Health Centre

(O) Physicians Office

(P) Hospital – Outpatient

(R) Patient’s Private Home

(S) PHC Community Location

(T) Practitioner’s Office – In Publicly Administered Facility

(Z) Other (e.g., accident site, in an ambulance, etc.)