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 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 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:
| 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.
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.”
| Weekdays | Mon. – Fri. “Sacrifice of Office hours” | Evenings (Monday – Friday) | 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 |
| Additional Person(s) Seen | K991: $20.00 Max. 9 | K993 : $40.00 Max. 9 | K995 : $60.00 Max. 9 | K999 : $75.00 Max. 9 | K997: $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 |
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 | C997: $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 |
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 | Elective Home Visit | |
|---|---|---|---|---|---|---|
| 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 | B960 $36.40 Max. 2 per time period |
| First Person Seen Maximums are total of 1st & additional person seen per time period | B990 : $27.50 Max. 10 | B992 : $44.00 Max. 10 | B994 : $66.00 Max. 10 | B993 : $82.50 Max. 20 | B996 : $110.00 Unlimited | $27.50 B990 Max. 10 |
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 Unlimited |
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 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.
