OHIP Special Visit Premiums

Courtney Marie L.
Jan. 18, 2023
9-minute read

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) 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:

WeekdaysMon. - Fri. "Sacrifice of Office hours")*Evenings (Monday - Friday)Weekends & HolidaysNights
07:00 - 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 & HolidaysNights
Travel PremiumK960 :
$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 SeenK990 :
$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) SeenK991:
$20.00 Max. 9
K993 :
$40.00 Max. 9
K995 :
$60.00 Max. 9
K999 :
$75.00 Max. 9
$100.00 Unlimited

Emergency Department by Emergency Department Physician

 WeekdaysEvenings Mon. - Fri.Weekends & HolidaysNights
Travel PremiumH960 : $36.40 Max.. 2H962 : $36.40 Max.. 2H963 : $36.40 Max.. 4H964 : $36.40 Unlimited
First Person SeenH980 : $20.00 Max.1H984 : $60.00 Max.1H988 : $75.00 Max.1H986 : $100.00 Unlimited
Additional 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 & HolidaysNights
Travel PremiumU960 : $36.40 Max. 2U961 : $36.40 Max. 2U962 : $36.40 Max. 2U963 : $36.40 Max. 6U964 : $36.40 Unlimited
First Person SeenU990 : $20.00 Max. 1U992 : $40.00 Max. 1U994 : $60.00 Max. 1U998 : $75.00 Max. 1U996 : $100.00 Unlimited
Additonal 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 & HolidaysNights
Travel PremiumC960 : $36.40 Max. 2C961 : $36.40 Max. 2C962 : $36.40 Max. 2C963 : $36.40 Max. 6C964 : $36.40 Unlimited
First Person SeenC990 : $20.00 Max. 1C992 : $40.00 Max. 1C994 : $60.00 Max. 1C986 : $75.00 Max. 1C996 : $100.00 Unlimited
Additonal 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 & HolidaysNights
Travel PremiumW960 : $36.40 Max. 2W961 : $36.40 Max. 2W962 : $36.40 Max. 2W963 : $36.40 Max. 6W964 : $36.40 Unlimited
First Person SeenW990 : $20.00 Max. 1W992 : $40.00 Max. 1W994 : $60.00 Max. 1W998 : $75.00 Max. 1W996 : $100.00 Unlimited
Additonal 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 Visit
Travel PremiumB960 : $36.40 Max. 2B961 : $36.40 Max. 2B962 : $36.40 Max. 2B963 : $36.40 Max. 6B964 : $36.40 UnlimitedB960
Max. 2 per time period
First Person Seen

Maximums are total of 1st & additional person seen per time period
B990 : $27.50 Max. 10B992 : $44.00 Max. 10B994 : $66.00 Max. 10B993 : $82.50 Max. 20B996 : $110.00 Unlimited$27.50 B990
Max. 10

Palliative Care Home Visit

 WeekdaysMon.-Fri. "Sacrifice of Office hours"Evenings Mon.-Fri.Weekends & HolidaysNights
Travel PremiumB966 : $36.40 UnlimitedB966 : $36.40 UnlimitedB966 : $36.40 UnlimitedB966 : $36.40 UnlimitedB966 : $36.40 Unlimited
First Person SeenB998 : $82.50 UnlimitedB998 : $82.50 UnlimitedB998 : $82.50 UnlimitedB998 : $82.50 UnlimitedB997 : $110.00 Unlimited

Physician Office

 WeekdaysEvenings Mon. - Fri.Weekends & HolidaysNights
Travel PremiumA960 : $36.40 Max.. 1A962 : $36.40 Max.. 1A963 : $36.40 Max.. 1A964 : $36.40 Unlimited
First 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 & HolidaysNights
Travel PremiumQ960 : $36.40 Max. 1Q961 : $36.40 Max. 1Q962 : $36.40 Max. 1Q963 : $36.40 Max. 1Q964 : $36.40 Unlimited
First 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 & HolidaysNights
Travel PremiumB986 : $36.40 UnlimitedB986 : $36.40 UnlimitedB986 : $36.40 UnlimitedB986 : $36.40 UnlimitedB986 : $36.40 Unlimited
First 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 & HolidaysNights
First 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.

Search All OHIP Billing Codes

Search the Ontario Schedule of Medical Benefits electronically. We’ve digitized all the OHIP billing codes so you can easily find the most up to date billing rules and amounts.

OHIP Billing Codes
Courtney Marie L
Writer and editor with a demonstrated history of working in the Canadian healthcare sector and the publishing industry. Skilled in writing, editing, proofreading, Spanish to English translation, and teaching English as a second language. Strong communications professional with a Bachelor of Arts in Geography and Political Science from the University of Manitoba.
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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 RBCx or its affiliates.

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