OHIP special visit premiums act like a bonus on top of regular fee codes and are incentives for physicians who have specific specialties or sub-specialties. You’ll also benefit from them if you work on weekends, late at night or on holidays. Therefore, they’re a great way to increase your monthly revenue!
However, while they do exist to make sure that you’re compensated for the extra work you do, there are several guidelines you need to know in order to use and benefit from them properly.
General Guidelines for OHIP Special Visit Premiums
In order to make sure you qualify and are using OHIP premiums properly, we’ve outlined all the rules and guidelines below. For a printable version
click here.
OHIP Special Visit Premium Rules
- May only be applied with non-elective (urgent and emergent) consults and assessments.
- May not be claimed for routine rounds.
- May not be claimed for visits to admit elective patients.
- Special visit premiums do not apply to subsequent hospital inpatient visits.
- Visit fees and related premiums must be kept together on the SAME bill.
- Always use the “A” prefix general listing visit codes. Billing Tip: Only use the A prefix consult and visit fees and not C prefix codes. The “C” prefix consult codes are strictly for non-emergency inpatient consults (and therefore no special visits apply). Our billing agents see this error ALL the time!
OHIP Special Visit Premiums can be used in 3 scenarios:
| Travel Premium | First Patient Seen | Additional Person(s) Seen |
|---|---|---|
| When you travel from any place other than the hospital where the service is performed. | Applies only to your first patient. (If your shift goes past midnight, you can bill it again). | Applies to each additional patient after you’ve billed your first patient. |
They are categorized into 5 different time brackets:
| Weekdays | Mon. – Fri. “Sacrifice of Office hours”) | Evenings (Monday – Friday) | Weekends & Holidays | Nights |
|---|---|---|---|---|
| 07:00 – 17:00 | 07:00 – 17:00 | 17:00 – 24:00 | 07:00 – 24:00 | 0:00 – 7:00 |
Note: “Sacrifice of Office” is when you have an unscheduled visit to Emergency or Hospital In-patient during regular office hours.
OHIP Special Visit Premiums (separated by department):
Each department below displays the scenario (on the left), the time bracket (above), and then:
The fee code
The amount of the fee code
The maximum times you can bill for it (per each time bracket).
Emergency Department
***These are not eligible for Emergency Department Physicians, please see “Emergency Department by Emergency Department Physician” below.
| Weekdays | Mon. – Fri. “Sacrifice of Office hours” | Evenings M-F | Weekends & Holidays | Nights | |
|---|---|---|---|---|---|
| Travel Premium | K960 : $36.40 Max. 2 | K961 : $36.40 Max. 2 | K962 : $36.40 Max. 2 | K963 : $36.40 Max. 6 | K964 : $36.40 Unlimited |
| First Person Seen | K990 : $20.00 Max. 1 | K992 : $40.00 Max. 1 | K994 : $60.00 Max. 1 | K998 : $75.00 Max. 1 | K996 : $100.00 Unlimited |
| Additonal Person(s) Seen | K991: $20.00 Max. 9 | K993: $40.00 Max. 9 | K995: $60.00 Max. 9 | K999: $75.00 Max. 19 | K997: $100.00 Unlimited |
Hospital Out-Patient Department
| Weekdays | Mon. – Fri. “Sacrifice of Office hours” | Evenings – Mon. – Fri. | Weekends & Holidays | Nights | |
|---|---|---|---|---|---|
| Travel Premium | U960 : $36.40 Max. 2 | U961 : $36.40 Max. 2 | U962 : $36.40 Max. 2 | U963 : $36.40 Max. 6 | U964 : $36.40 Unlimited |
| First Person Seen | U990 : $20.00 Max. 1 | U992 : $40.00 Max. 1 | U994 : $60.00 Max. 1 | U998 : $75.00 Max. 1 | U996 : $100.00 Unlimited |
| Additonal Person(s) Seen | U991: $20.00 Max. 9 | U993: $40.00 Max. 9 | U995: $60.00 Max. 9 | U999: $75.00 Max. 19 | U997: $100.00 Unlimited |
Hospital In-Patient
| Weekdays | Mon. – Fri. “Sacrifice of Office hours” | Evenings Mon. – Fri. | Weekends & Holidays | Nights | |
|---|---|---|---|---|---|
| Travel Premium | C960 : $36.40 Max. 2 | C961 : $36.40 Max. 2 | C962 : $36.40 Max. 2 | C963 : $36.40 Max. 6 | C964 : $36.40 Unlimited |
| First Person Seen | C990 : $20.00 Max. 1 | C992 : $40.00 Max. 1 | C994 : $60.00 Max. 1 | C986 : $75.00 Max. 1 | C996 : $100.00 Unlimited |
| Additonal Person(s) Seen | C991: $20.00 Max. 9 | C993: $40.00 Max. 9 | C995: $60.00 Max. 9 | C987: $75.00 Max. 19 | U997: $100.00 Unlimited |
Long Term Care Institution
| Weekdays | Mon. – Fri. “Sacrifice of Office hours” | Evenings Mon. – Fri. | Weekends & Holidays | Nights | |
|---|---|---|---|---|---|
| Travel Premium | W960 : $36.40 Max. 2 | W961 : $36.40 Max. 2 | W962 : $36.40 Max. 2 | W963 : $36.40 Max. 6 | W964 : $36.40 Unlimited |
| First Person Seen | W990 : $20.00 Max. 1 | W992 : $40.00 Max. 1 | W994 : $60.00 Max. 1 | W998 : $75.00 Max. 1 | W996 : $100.00 Unlimited |
| Additonal Person(s) Seen | W991: $20.00 Max. 9 | W993: $40.00 Max. 9 | W995: $60.00 Max. 9 | W999: $75.00 Max. 19 | W997: $100.00 Unlimited |
Emergency Department by Emergency Department Physician
| Weekdays | Evenings Mon. – Fri. | Weekends & Holidays | Nights | |
|---|---|---|---|---|
| Travel Premium | H960 : $36.40 Max.. 2 | H962 : $36.40 Max.. 2 | H963 : $36.40 Max.. 4 | H964 : $36.40 Unlimited |
| First Person Seen | H980 : $20.00 Max.1 | H984 : $60.00 Max.1 | H988 : $75.00 Max.1 | H986 : $100.00 Unlimited |
| Additional Person(s) Seen | H981 : $20.00 Max.4 | H985 : $60.00 Max.4 | H989 : $75.00 Max.9 | H987 : $100.00 Unlimited |
Special Visit to a Patient’s Home
(Excluding Long-Term Care Institutions).
Note: elective stands for home visits.
| Weekdays – Both Elective & non-elective | Mon.-Fri. “Sacrifice of Office hours” non-elective | Evenings Mon.-Fri. non-elective | Weekends & Holidays – non-elective | Nights – non-elective | |
|---|---|---|---|---|---|
| Travel Premium | B960 : $36.40 Max. 2 | B961 : $36.40 Max. 2 | B962 : $36.40 Max. 2 | B963 : $36.40 Max. 6 | B964 : $36.40 Unlimited |
| First Person Seen | B990 : $27.50 Max. 10 | B992 : $44.00 Max. 10 | B994 : $66.00 Max. 10 | B993 : $$82.50 Max. 20 | B996 : $110.00 Unlimited |
Palliative Care Home Visit
| Weekdays | Mon.-Fri. “Sacrifice of Office hours” | Evenings Mon.-Fri. | Weekends & Holidays | Nights | |
|---|---|---|---|---|---|
| Travel Premium | B966 : $36.40 Unlimited | B966 : $36.40 Unlimited | B966 : $36.40 Unlimited | B966 : $36.40 Unlimited | B966 : $36.40 Unlimited |
| First Person Seen | B998 : $82.50 Unlimited | B998 : $82.50 Unlimited | B998 : $82.50 Unlimited | B998 : $82.50 Unlimited | B997 : $110.00 Unlimited |
Physician Office
| Weekdays | Evenings Mon. – Fri. | Weekends & Holidays | Nights | |
|---|---|---|---|---|
| Travel Premium | A960 : $36.40 Max.. 1 | A962 : $36.40 Max.. 1 | A963 : $36.40 Max.. 1 | A964 : $36.40 Unlimited |
| First Person Seen | A990 : $20.00 Max.1 | A994 : $60.00 Max.1 | A998 : $75.00 Max.1 | A996 : $100.00 Unlimited |
Other (non-professional setting not listed)
| Weekdays | Mon.-Fri. “Sacrifice of Office hours” | Evenings Mon.-Fri. | Weekends & Holidays | Nights | |
|---|---|---|---|---|---|
| Travel Premium | Q960 : $36.40 Max. 1 | Q961 : $36.40 Max. 1 | Q962 : $36.40 Max. 1 | Q963 : $36.40 Max. 1 | Q964 : $36.40 Unlimited |
| First Person Seen | Q990 : $20.00 Max. 1 | Q992 : $40.00 Max. 1 | Q994 : $60.00 Max. 1 | Q998 : $75.00 Max. 1 | Q996 : $100.00 Max. 1 |
Geriatric Home Visit
| Weekdays | Mon.-Fri. “Sacrifice of Office hours” | Evenings Mon.-Fri. | Weekends & Holidays | Nights | |
|---|---|---|---|---|---|
| Travel Premium | B986 : $36.40 Unlimited | B986 : $36.40 Unlimited | B986 : $36.40 Unlimited | B986 : $36.40 Unlimited | B986 : $36.40 Unlimited |
| First Person Seen | B988 : $82.50 Unlimited | B988 : $82.50 Unlimited | B988 : $82.50 Unlimited | B988 : $82.50 Unlimited | B987 : $110.00 Unlimited |
Obstetrical Delivery with Sacrifice of Office Hours
| Weekdays | “Sacrifice of Office hours” | Evenings Mon.-Fri. | Weekends & Holidays | Nights | |
|---|---|---|---|---|---|
| First Person Seen | $0.00 | C989 : $76.40 Unlimited | $0.00 | $0.00 | $0.00 |
Billing Tips:
When billing OHIP premiums, make sure to include:
- Time
- Department
- Requested by (Physician or Nurse)
- Travel – you can bill up to 2 travel premiums per day and 6 on weekends/holidays, but it must be documented that you left the facility grounds and had to return in order to receive payment for 2nd travel premium.
- First patient seen
- Be sure to use premiums that MATCH the SLI (service location indicator) on the claim.Note: If a patient is being seen in the Emergency Department but is being admitted use the SLI – HIP but use Emergency Department special visit premiums AND enter the admission date. This indicates to OHIP that the patient was seen in ER and then admitted. This is especially important if you are billing E082 (admission assessment by MRP).
Want to maximize your earnings? New to Ontario Billing?
Check out our Ultimate OHIP Billing Guide that takes you through every step for billing successfully in Ontario.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
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