Hour of Power (0700–0759): Night rates apply until 0800.
L2 night is $148.93 vs L2 day $93.48, nearly double. Document start times accurately.
MSP BillBudED billing pearls, myths and pitfalls
26 quick lessons in BC MSP billing for emergency physicians: the fees people miss, the rules people get wrong, and the combinations MSP rejects. Share any of them as an image for a group chat or the department notice board.
Pearls
Fees that are easy to miss.
Splints for carpal tunnel & de Quervain's are billable.
Even low-acuity presentations with a molded splint get ~$12 extra (510XX at 50% as the lesser fee). Commonly missed.
GA upgrade for abscesses pays 3× more.
07027 (deep abscess under GA) $255.34 vs 07059 under LA $83.30. If sedation is clinically appropriate, always present the GA option.
Dental pain: a nerve block plus L1 at 50% comes to ~$88 (01124).
The nerve block is therapeutic and billable since there's no procedure code in the encounter. The 50% rule halves the lesser fee (the level code).
Another doctor called you for advice? CCFP-EM: 14021 ($69.64) for calls up to 22 min, 01881 ×2 ($120) beyond.
FRCPC can only bill 01881. The 22-minute threshold nearly doubles the fee. Document call duration carefully.
01880 follow-up call: $44.35 for any ED patient within 14 days.
Can be any colleague's patient. Higher than 14023 ($23.19). Must alter the management plan.
Miscellaneous codes (00199/01899) allow custom fee billing.
For procedures with no specific MSP code. Submit with comparable code justification. Expect initial rejection, then approval on chart review.
EUA code (S70683) $178.68, commonly missed for anal stricture dilatation.
For anal stricture dilatation under anesthesia (i.e., DRE on patient with anal stricture). Do NOT use for rectal prolapse reduction; use miscellaneous codes instead.
Rectal prolapse reduction → bill miscellaneous codes (00199/01899).
No specific MSP code exists. Submit under 00199 (CCFP-EM) or 01899 (FRCPC) with comparable surgical code justification. [Reasonable comparators: shoulder reduction no-GA (52721) $95.49 or shoulder reduction with-GA (52722) $255.56.] Expect initial rejection, then approval on chart review.
IV ketamine for chronic pain (01160) pays $124.27.
For refractory chronic pain (CRPS, neuropathic pain crisis), NOT acute procedural sedation. Billed with the level code under the 50% rule (the level code is halved). Rarely billed but legitimate and lucrative.
Blood transfusion (00021): $40.79, paid at 50% ($20.40) on top of the level code.
Bill when you personally administer or directly supervise a transfusion. Rarely billed but legitimate.
Myths
Things commonly believed about MSP billing that aren't so.
You can bill sedation codes alongside a procedure code.
Sedation (01172/01173) is a standalone billing path: it CANNOT be billed alongside ANY procedure code, whether with-GA (e.g. 54702) or no-GA (e.g. 54701). Choose one path: procedure code OR sedation codes alone.
Nerve blocks (01124) are always billable when you perform one.
01124/01125 are rejected if billed alongside any procedure code. Only billable for standalone therapeutic/diagnostic use.
You can bill a level code AND a fracture code (01850/01851).
EM fracture codes REPLACE the level code: you cannot bill both. Choose whichever pays more.
Reassessment (01882) can be billed anytime you re-examine a patient.
01882 requires ≥2h after L2/consult or ≥3h after L3, plus documented medical necessity and change in management.
The 50% rule means procedures are always billed at 50%.
The LESSER fee is halved. If the procedure exceeds the level code, the level code gets 50%, not the procedure.
Hematoma blocks count as procedural sedation and justify a with-GA code.
Hematoma blocks are local anesthetic, not sedation. Bill the no-GA reduction code (e.g. 54701), not the with-GA code.
Specialist advice codes (14018/78711) can't be billed if the specialist comes in to see the patient.
Any advice a specialist gives is billable, even if they later see the patient (e.g. CTU asks for a BNP, ortho says no splint and see in clinic). Document the advice and the staff specialist's name.
01870 resuscitation is only for cardiac arrests.
Any life/limb/sight-threatening scenario qualifies. Septic shock, tension pneumothorax, priapism are all valid if documented.
Dermabond or steristrips require the 13611 code.
13610 ($40.64) is correct for no-anesthetic closures. 13611 ($75.71) requires local anesthetic injection.
Pitfalls
Billing that gets rejected, or pays less than it could.
Billing 01124 nerve block alongside a lac repair will be rejected.
MSP rejects nerve blocks billed with any procedure code. The block must be for standalone therapeutic/diagnostic use only.
CVC (00017) only pays $26.63; consider resus billing instead.
If placed during a life-threatening resus, billing 01870 for the time at bedside is far more lucrative.
Cardioversion + sedation codes cannot be billed together.
Consider 01870 resus instead: with a level code, resus beats cardioversion after just 5 to 10 minutes at the bedside, since the 50% rule halves the cardioversion but never resus.
Weekend fracture codes may pay LESS than a weekend L2.
Weekend L2 ($123.02) exceeds clavicle ($107.99) and fibula ($93.40) fracture codes. If documentation supports L2, bill the level code.
Cast/splint codes are NOT payable with any fracture reduction code.
Splinting is included in both with-GA and no-GA reduction codes. Cast/splint codes (510XX) are only billable for non-displaced fractures where no reduction is performed.
MSP audits clusters of patients billed at 0700–0759.
The Hour of Power is legitimate but MSP flags implausibly tight start times. Document accurately per chart.
Fees per the MSC Payment Schedule dated May 31, 2026. Not official billing advice.
Ask BillBud about your own case