Alberta physician billing decision support
Claim lines and chart evidence from the Alberta Schedule
One encounter produces claim lines, rule checks and a chart note tied to the April 2026 Alberta Schedule.
Encounter
Claim lines
April 2026
03.03A
Limited assessment
G75GP applied, 20 percent above the GP rate for a patient 75 or older
$48.28
CMGP02
Complexity, 2 units
First unit at 15 minutes, one more for each full 10 after that
$39.08
Demonstration against the April 2026 Schedule, general practice office visits. The physician is responsible for every claim submitted.
Office visit worked example
Patient aged 78, several chronic conditions, 25 minutes of physician time with start and stop times charted.
Coded from habit
Coded from the rules
- 03.03ALimited assessment$40.23
- G75GPAge modifier, 120 percent$8.05
- CMGP02Complexity, 2 units$39.08
$47.13 more, same visit
Four outputs from one encounter
The claim lines
| 03.03A | Limited assessmentG75GP, 120 percent for a patient 75 or older | $48.28 |
| CMGP02 | Complexity, 2 units25 minutes recorded | $39.08 |
Worth checking
For a cardiac or chest presentation, an office ECG is claimable with the visit.
03.52A $17.90 technical · 03.52B $9.83 interpretation
Add ECGRaised as a question. Nothing is added to the claim unless the physician adds it.
Decisions and cautions
Time record needed
This code is paid by time. General Rule 2.3.6 requires a documented time record for each day of service. Without it the claim is not supportable.
Forty-four of the rules are hard stops. Each one names the rule that refused the claim.
The chart note
SUBJECTIVE
Seen in the office for [stated concern].
ASSESSMENT
Hypertension with type 2 diabetes, review of control.
TIME AND SERVICES
Total physician time on management today, [start and stop].
Anything the physician has to confirm or edit is marked. Ready to paste into the record.
Six common revenue gaps
- $30 to $91
Wrong visit tier
A limited assessment where the note supports a full one
- $44.92 to $54.97
Conferences and calls
Treated as unpaid administration
- $11 to $44
Small procedures
Done during a visit, never entered separately
- $15.78 to $31.59
Time based visits
Prolonged codes, CMXV and CMXC additions
- $19.54 a unit
Complexity modifier
CMGP, and it repeats by unit
- $8.05
Age premium
G75GP, easy to forget on a routine visit
Modelled payback
Set the volume and the recovery assumption to see what the subscription returns.
Added billings a year
$19,020
Subscription cost
$199.17 a month*
Net gain a year
$16,630
Return
8.0x
*Billed annually at $2,390, which is 17 percent less than paying monthly.
Every figure is modelled, without guarantee. The baseline review replaces these assumptions with the physician's own numbers.
Full model, with specialty, payback timing and sourcesAudit support in every result
0
Hard stops
Combinations the written rules do not support. Each one names the rule that refused the claim.
0
Source documents
Alberta Health publications, April 2026 edition. Every line cites the page or general rule behind it.
0
Specialties live
General practice, psychiatry and cardiology, each narrowing the Schedule to that work.
A recovery action on unsupported time codes can exceed several years of subscription fees. The physician still reviews every line against the care and chart.
One encounter against the April 2026 Schedule
Review the claim lines, cautions and chart evidence produced from the facts entered.