Family physician's first report after the initial assessment when injuries did not cause missed work/school or significant impairment of daily living.
- Completed by
- Family physician
- Issued by
- ICBC
- Format
- Fillable PDF
- Language
- English
ICBC CL489S: Physician Specialized Services Report
Physicians who see an ICBC patient on referral from another physician or a nurse practitioner use this four-page report, including specialists and family physicians focused on sports medicine. It applies only to crashes on or after May 1, 2021 and records diagnoses with ICD-9 codes, vocational and avocational status, restrictions, barriers to recovery, a care management plan and prognosis.
Who completes it
The consulting physician completes and certifies the whole report, including specialty and MSP practitioner number, and confirms patient consent or an ICBC request under section 28 or 28.1 of the Insurance (Vehicle) Act.
Submitting and payment
- How to submit it
- Submit it through an EMR-integrated version or by fax or mail no later than 30 days from the date of assessment. The consultation itself is billed separately through MSP Teleplan using the standard MSP visit codes.
- Who pays
- ICBC pays the report under fee code A94573, and the report acts as the invoice once ICBC receives it, so no separate invoice is needed.
Good to know
- The appendix lists common ICD-9 codes, including 300 and 309 for mental disorders, 840 to 848 for sprains and strains, 850 for concussion and 920 to 924 for contusions.
- Vocational status covers homemaking and caregiving as well as work, training and study, and asks whether you support a gradual return to work and from when.
- ICBC's family physician reports are separate forms, the CL489, CL489A and CL489B, each with its own fee code.
Get the official form
Download the current version from the source each time; forms change without notice.
Physician Specialized Services Report
Fill it with Vero
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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Frequently asked questions
Who can bill ICBC for a CL489S?
A physician providing a consultation requested by another physician or a nurse practitioner, for a patient whose crash occurred on or after May 1, 2021. ICBC's physicians page says this includes specialists and family physicians with a focus on sports medicine. The report is paid under fee code A94573.
Do I need a separate invoice for the CL489S?
No. The form states that the report acts as the invoice once ICBC receives it. Enter your ICBC vendor number so payments are combined with a statement listing paid reports; the invoice or reference number field is optional but helps reconcile payments. Bill the consultation itself through MSP Teleplan.