Expedited Surgical Premium Guide

The Expedited Surgery Premium (ESP) is an extra fee paid in addition to the applicable MSP fees for WorkSafeBC-approved surgeries, when the surgery is performed within a faster timeframe.

A surgery is considered “expedited” if it occurs within 40 business days from the date a surgeon receives written approval for surgery from a WorkSafeBC board officer.

Surgical procedures eligible for ESP include a specific subset of all surgery fee items from the MSP fee guide. The procedures included in this list were negotiated and agreed upon by Doctors of BC and WorkSafeBC. 

The ESP is automatically applied to surgery payments for eligible surgeries billed through Teleplan. 

Using the process outlined below, surgeons may bill WorkSafeBC for multiple procedures in a manner consistent with the current practice of billing MSP for multiple procedures. The usual payment rules from the MSC Payment Schedule and its preambles will apply before the ESP premium is calculated.

This diagram describes the ESP qualification process.

Note: If you perform emergency surgeries, you will not need to wait for WorkSafeBC’s approval. See below for emergency surgery details.

If an injured worker declines the scheduled surgery date and requires a new date outside the 40-business-day period for a surgery that qualifies under ESP timelines, the surgeon can request an exception. 

Contact WorkSafeBC’s Health Care Programs department at +1 866 244-6404 and select ‘2’, or email hcsinqu@worksafebc.com.

Exceptions to the 40-business-day expedited surgery requirement are considered on a case-by-case basis. Approval for this exception cannot be requested from the claim owner/injured worker, as they do not have the authority to approve exceptions.

If you perform emergency surgeries, you will not need to wait for WorkSafeBC’s approval. For emergency surgery, submit a consultation report and invoice fee with item 19326, using the surgery date as the service date to qualify for ESP.

In cases of emergency or trauma surgery, the surgeon must submit the prescribed Authorization for Surgery Form (Form 83D6 – Authorization Request for Surgery) within five business days after the surgery to the WorkSafeBC board officer, along with the comprehensive consultation report. Physicians should also bill fee code 19326 using the surgery date as the date of service.

The most reliable way to begin the ESP qualification period, during which a surgery can qualify for the ESP surcharge, is to bill fee code 19326 promptly after receiving WorkSafeBC’s written approval for the surgery. 

• It is essential for surgeons to mark this date in Teleplan by invoicing for fee code 19326 and using the approval as the Service Date. This initiates the 40-business-day period during which a surgery will be considered “expedited.”
• If fee code 19326 is not billed, eligibility for the ESP depends on the submission of fee code 19911, 19912, or 19908. WorkSafeBC will use the most recent service dates to determine the start of the 40-business-day ESP qualification period. 

For ESP qualification, fee items 19326, 19911, 19912, or 19908 must be billed electronically through Teleplan. You must invoice using the same payee number for all invoicing related to a surgical procedure.

However, if these fee items are not paid (for example, if you did not submit the associated consult report, or the report is incomplete) this will prevent the ESP qualification period from starting, and the surgical procedures will not qualify for the ESP. 

Expedited surgical assist or expedited anesthesia invoice refusal

In this case, it is most likely that the surgery did not qualify for ESP. Possible reasons for this may originate from the primary surgeon and be related to the use of multiple payee numbers for invoices associated with the surgical procedure.

If you are a surgical assistant or anesthesiologist who was refused a fee for qualified expedited services, please contact WorkSafeBC Payment Services at +1 888 422-2228.

Troubleshooting ESP payment questions

If you received payment for a surgery, but did not receive the ESP surcharge at the same time, it likely means the surgery did not qualify for the ESP. The ESP surcharge is only paid when the surgery’s base fees are paid. You will not receive the ESP payment separately later. You can dispute an unpaid ESP surcharge by contacting WorkSafeBC Payment Services at +1 888 422-2228. 

If it is unclear whether you received the ESP for a surgery, check your medical billing software under “Adjustment Code 31”; the ESP amount should be listed there. Please note that numerous medical billing software packages are in use, each with its own unique features. Not all software may display payment information such as “Adjustment Code 31,” and those that do may show it differently.

Common reasons for ESP rejections

• Not invoicing fee code 19326 (or 19911 or 19912 or 19908) to mark the start of the 40-business-day ESP qualification period.
• Not performing the surgery within the ESP qualification period.
• Forgetting to submit a pre-surgery consult report.
• Incorrect dates on consult reports or invoices.

Joint replacement surgery is an exception to the 40-business-day rule. The ESP qualification period for this procedure is 183 calendar days.  

Extensive spine surgery procedures are not eligible for the ESP premium. Expedited extensive spinal surgeries and anesthesiology services are paid through a different model. Pleas refer to the Physicians and Surgeons’ WorkSafeBC Services Agreement for details.