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, nights or holidays. General Guidelines for OHIP Special Visit Premiums While these premiums exist to compensate you for the extra work you do, there are several guidelines you need to know in order to use and benefit from them properly: 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. 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). This is a very common error that will result in a rejected claim. For a complete list of payment rules, see the Special Visit Premiums section in the OHIP Schedule of Benefits. OHIP Special Visit Premiums Scenarios and Times Travel PremiumFirst Patient SeenAdditional Person(s) SeenWhen 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 until you leave the facility.* *Note: If you leave a facility, but are called back again, you may start the cycle over and bill for another travel premium, first patient seen and so on. (Ensure documentation when billing additional travel premiums during the same day/time period. They are categorized into 5 different time brackets: WeekdaysMon. - Fri. "Sacrifice of Office hours")*Evenings (Monday - Friday)Weekends & HolidaysNights07:00 - 17:0007:00 - 17:0017:00 - 24:0007:00 - 24:000:00 - 7:00 *Note: “Sacrifice of Office” is when you have an unscheduled visit to Emergency or Hospital In-patient during regular office hours. Special Visit Premium Codes and Amounts by Care Type Quickly determine the applicable code and dollar value using the charts below. Download a printable version, For complete guidelines on code application and exclusions, see the Special Visit Premiums section in the OHIP Schedule of Benefits. Emergency Department Note these codes are not eligible for Emergency Department Physicians. Emergency Department Physicians should refer to the next chart: “Emergency Department by Emergency Department Physician.” WeekdaysMon. – Fri. “Sacrifice of Office hours”Evenings (Monday – Friday)Weekends & HolidaysNightsTravel PremiumK960 : $36.40 Max. 2K961 : $36.40 Max. 2K962 : $36.40 Max. 2K963 : $36.40 Max. 6K964 :$36.40 UnlimitedFirst Person SeenK990 : $20.00 Max. 1K992 : $40.00 Max. 1K994 : $60.00 Max. 1K998 : $75.00 Max. 1K996 : $100.00 UnlimitedAdditional Person(s) SeenK991: $20.00 Max. 9K993 : $40.00 Max. 9K995 : $60.00 Max. 9K999 : $75.00 Max. 9K997: $100.00 Unlimited Emergency Department by Emergency Department Physician WeekdaysEvenings Mon. - Fri.Weekends & HolidaysNightsTravel PremiumH960 : $36.40 Max.. 2H962 : $36.40 Max.. 2H963 : $36.40 Max.. 4H964 : $36.40 UnlimitedFirst Person SeenH980 : $20.00 Max.1H984 : $60.00 Max.1H988 : $75.00 Max.1H986 : $100.00 UnlimitedAdditional Person(s) SeenH981 : $20.00 Max.4H985 : $60.00 Max.4H989 : $75.00 Max.9H987 : $100.00 Unlimited Hospital Out-Patient Department WeekdaysMon. - Fri. "Sacrifice of Office hours"Evenings - Mon. - Fri.Weekends & HolidaysNightsTravel PremiumU960 : $36.40 Max. 2U961 : $36.40 Max. 2U962 : $36.40 Max. 2U963 : $36.40 Max. 6U964 : $36.40 UnlimitedFirst Person SeenU990 : $20.00 Max. 1U992 : $40.00 Max. 1U994 : $60.00 Max. 1U998 : $75.00 Max. 1U996 : $100.00 UnlimitedAdditonal Person(s) SeenU991: $20.00 Max. 9U993: $40.00 Max. 9U995: $60.00 Max. 9U999: $75.00 Max. 19U997: $100.00 Unlimited Hospital In-Patient WeekdaysMon. - Fri. "Sacrifice of Office hours"Evenings Mon. - Fri.Weekends & HolidaysNightsTravel PremiumC960 : $36.40 Max. 2C961 : $36.40 Max. 2C962 : $36.40 Max. 2C963 : $36.40 Max. 6C964 : $36.40 UnlimitedFirst Person SeenC990 : $20.00 Max. 1C992 : $40.00 Max. 1C994 : $60.00 Max. 1C986 : $75.00 Max. 1C996 : $100.00 UnlimitedAdditonal Person(s) SeenC991: $20.00 Max. 9C993: $40.00 Max. 9C995: $60.00 Max. 9C987: $75.00 Max. 19C997: $100.00 Unlimited Long Term Care Institution WeekdaysMon. - Fri. "Sacrifice of Office hours"Evenings Mon. - Fri.Weekends & HolidaysNightsTravel PremiumW960 : $36.40 Max. 2W961 : $36.40 Max. 2W962 : $36.40 Max. 2W963 : $36.40 Max. 6W964 : $36.40 UnlimitedFirst Person SeenW990 : $20.00 Max. 1W992 : $40.00 Max. 1W994 : $60.00 Max. 1W998 : $75.00 Max. 1W996 : $100.00 UnlimitedAdditonal Person(s) SeenW991: $20.00 Max. 9W993: $40.00 Max. 9W995: $60.00 Max. 9W999: $75.00 Max. 19W997: $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-electiveMon.-Fri. "Sacrifice of Office hours" non-electiveEvenings Mon.-Fri. non-electiveWeekends & Holidays - non-electiveNights - non-electiveElective Home VisitTravel PremiumB960 : $36.40 Max. 2B961 : $36.40 Max. 2B962 : $36.40 Max. 2B963 : $36.40 Max. 6B964 : $36.40 UnlimitedB960$36.40Max. 2 per time periodFirst Person SeenMaximums are total of 1st & additional person seen per time periodB990 : $27.50 Max. 10B992 : $44.00 Max. 10B994 : $66.00 Max. 10B993 : $82.50 Max. 20B996 : $110.00 Unlimited$27.50 B990Max. 10 Palliative Care Home Visit WeekdaysMon.-Fri. "Sacrifice of Office hours"Evenings Mon.-Fri.Weekends & HolidaysNightsTravel PremiumB966 : $36.40 UnlimitedB966 : $36.40 UnlimitedB966 : $36.40 UnlimitedB966 : $36.40 UnlimitedB966 : $36.40 UnlimitedFirst Person SeenB998 : $82.50 UnlimitedB998 : $82.50 UnlimitedB998 : $82.50 UnlimitedB998 : $82.50 UnlimitedB997 : $110.00 Unlimited Physician Office WeekdaysEvenings Mon. - Fri.Weekends & HolidaysNightsTravel PremiumA960 : $36.40 Max.. 1A962 : $36.40 Max.. 1A963 : $36.40 Max.. 1A964 : $36.40 UnlimitedFirst Person SeenA990 : $20.00 Max.1A994 : $60.00 Max.1A998 : $75.00 Max.1A996 : $100.00 Unlimited Other (non-professional setting not listed) WeekdaysMon.-Fri. "Sacrifice of Office hours"Evenings Mon.-Fri.Weekends & HolidaysNightsTravel PremiumQ960 : $36.40 Max. 1Q961 : $36.40 Max. 1Q962 : $36.40 Max. 1Q963 : $36.40 Max. 1Q964 : $36.40 UnlimitedFirst Person SeenQ990 : $20.00 Max. 1Q992 : $40.00 Max. 1Q994 : $60.00 Max. 1Q998 : $75.00 Max. 1Q996 : $100.00 Unlimited Geriatric Home Visit WeekdaysMon.-Fri. "Sacrifice of Office hours"Evenings Mon.-Fri.Weekends & HolidaysNightsTravel PremiumB986 : $36.40 UnlimitedB986 : $36.40 UnlimitedB986 : $36.40 UnlimitedB986 : $36.40 UnlimitedB986 : $36.40 UnlimitedFirst Person SeenB988 : $82.50 UnlimitedB988 : $82.50 UnlimitedB988 : $82.50 UnlimitedB988 : $82.50 UnlimitedB987 : $110.00 Unlimited Obstetrical Delivery with Sacrifice of Office Hours Weekdays"Sacrifice of Office hours"Evenings Mon.-Fri.Weekends & HolidaysNightsFirst Person Seen$0.00C989 : $76.40 Max. 1 per time period$0.00$0.00$0.00 Billing Tips for Special Visit Premiums: When billing OHIP premiums, make sure to include: Time Department Requested by (Physician or Nurse) Travel – When billing more than one travel premium for the same facility, it must be documented that you left the facility grounds and had to return 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). MoH & OMA Special Visit Premiums Resource For more information regarding Special Visit Premiums, including scenario-specific examples, refer to the Special Visit Premium Resource Guide provided by the Ministry of Health and Ontario Medical Association. Download our Ultimate OHIP Billing Guide New to billing? Get more information in our Ultimate OHIP Billing Guide on adding premiums, managing rejections and using billing best practices. Read Our Latest eBook Family Physician’s Guide to Billing in Ontario Get the e-book Get the e-book
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