OHIP Special Visit Premium

Key Takeaways

• OHIP special visit premiums are added on top of regular fee codes for urgent or emergency consults and assessments.
  
  
• They are paid per setting (ER, inpatient, outpatient, long-term care, home) and by time bracket: weekdays, sacrifice of office hours, evenings, weekends/holidays, and nights.
  
  
• To get OHIP special visit claims paid, use A-prefix consult and visit codes rather than C-prefix codes. 
  
  
• Keep the visit fee and its premiums on the same bill, and match the premiums to the service location indicator (SLI).
  
  
• Check current billing codes 2026 against the OHIP Schedule of Benefits before you submit.
  
  

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.

What are the 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

*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:

*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: Practical Billing Example

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.”

Emergency Department by Emergency Department Physician

Hospital Out-Patient Department

Hospital In-Patient

Long Term Care Institution

Special Visit to a Patient’s Home

(Excluding Long-Term Care Institutions).
Note: elective stands for home visits.

Palliative Care Home Visit

Physician Office

Other (non-professional setting not listed)

Geriatric Home Visit

Obstetrical Delivery with Sacrifice of Office Hours

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.

FAQ

1. What is an OHIP special visit premium?
   
   
   • A special visit premium (SVP) is an additional payment on top of the regular assessment fee, paid when a physician makes an unscheduled, urgent visit to a patient It includes three separately billable components:  a travel premium, a first person seen premium and an additional person seen premium. The amount depends on where and when you see the patient.
     
     
2. When can I claim an OHIP special visit premium?
   
   
   • You can claim a special visit premium (SVP) only for an unscheduled, non-elective (urgent or emergent) consults and assessments that cannot wait more than 24 hours. The visit must be initiated by the patient or a patient representative (e.g., a nurse); SVPs are not payable for routine rounds or elective admissions.
     
     
3. Can I claim a special visit premium for elective admissions?
   
   
   • No. Special visit premiums can’t be claimed for visits to admit elective patients or for routine rounds
     
     
4. Do special visit premiums apply to subsequent hospital inpatient visits?
    
   
   • No. Subsequent inpatient visits aren’t eligible. If you’re called in urgently, bill an A-prefix consult or assessment with the premiums instead.
     
     
5. What information must I include when billing an OHIP special visit premium?
   
   
   • Include the following on the claim:
     •  Time of the visit (must also be documented in the patient’s medical record)
     • Department where the patient was seen
     • Who requested the visit (physician or nurse)
     • First patient seen (identify which patient was the first on the trip)
     • Travel documentation if you claim more than one travel premium for the same facility, you must document that you left the facility grounds and returned
       
       
   • Two additional billing rules:
     • Use premiums that match the SLI (service location indicator) on the claim.
     • Visit fees and related premiums must be on the same bill.

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