Billing code
E088A — Congestive Heart Failure Premium - Add 50% For Virutal Services
Congestive heart failure premium
Add to a cardiologist's office or out-patient clinic assessment of a patient with established congestive heart failure.
Watch for: Bill with A603, A604, A601 or A608 and diagnostic code 428; not for in-patients or emergency patients.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $0.01 | $0.00 | $0.00 | $0.00 |
- Code
- E088A
- Description
- Congestive Heart Failure Premium - Add 50% For Virutal Services
- FHO+ basket
- Not in the FHO+ base rate basket (Schedule 2 or 2B).
- Effective date
- Apr 1, 2023
- Termination date
- No end date
Explanation
Updated October 26, 2026
Premium added to a cardiologist's office or out-patient clinic assessment of a patient with established congestive heart failure.
What it covers
The congestive heart failure premium is added to an assessment by a cardiology specialist (60) when the assessment is a medical specific assessment, medical specific re-assessment, complex medical specific re-assessment or partial assessment (A79).
The assessment must be in an office or a hospital out-patient clinic (not an emergency department), and the patient must have an established diagnosis of congestive heart failure documented in the chart (A79).
Billing rules
- Only with A603, A604, A601 or A608 by a cardiologist (A79).
- Not payable for hospital in-patients, LTC patients or patients seen in an emergency department (A79).
- Submit the claim with diagnostic code 428 (A80).
- Payable on comprehensive virtual care services (A74).
Often billed with
- A603, A604, A601 or A608 (A79).
Common rejections
- AD9: 'Premium not allowed alone': E088 must be on the same claim as an eligible cardiology assessment (A79).
- A4D: 'Invalid specialty for this service code': E088 is payable only to cardiology specialists (60) (A79).
Related codes: A603, A604, A601, A608, E078
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Cardiology (60), page A79–A80.
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