travel premium code ohip

OHIP Special Visit Premiums

• General Guidelines for OHIP Special Visit Premiums
• OHIP Special Visit Premiums can be used in 3 scenarios:
• Emergency Department
• Emergency Department by Emergency Department Physician
• Special Visit to a Patient's Home
• Palliative Care Home Visit
• Physician Office
• Other (non-professional setting not listed)
• Geriatric Home Visit
• Obstetrical Delivery with Sacrifice of Office Hours
• Want to maximize your earnings? New to Ontario Billing?

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.

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!

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.

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).

***These are not eligible for Emergency Department Physicians, please see “Emergency Department by Emergency Department Physician” below.

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.

Billing Tips:

When billing ohip premiums, make sure to include:.

• 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).

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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• OHIP Billing Support – How to Bill E078 (the Chronic Disease Premium)
• OHIP Billing Codes Sheet for General / Family Practitioners

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Special Visit Premiums

How they work & when to use them.

Special Visit Premium Codes (SVPs) act like a bonus on top of your fee service codes. This incentive is used to compensate physicians who have specific specialties or sub-specialties or who provide care outside of their regular schedule. They can significantly increase your monthly revenue, however they can only be used in conjunction with an appropriate A-prefix consult or assessment fee. SVP’s can also provide you extra earnings if you work on a holiday or weekend, see below for a list of holidays.

The Ministry of Health’s Special Visit Premium dates observed.

They can be broken down into four time brackets:

• Weekdays – Daytime (07:00 – 17:00) OR Weekdays – Daytime (07:00 – 17:00) with Sacrifice of Office Hours
• Evenings – (17:00 – 24:00) Monday through Friday
• Sat, Sun & Holidays (07:00 – 24:00)
• Nights – (00:00 – 07:00)

They can be applied in 3 scenarios:

• Travel Premium — applies when you travel from any place other than the hospital where the service is performed.
• First Patient Seen — applies to your first patient seen. *If your shift spans past midnight, you can bill another ‘first persons seen’ for that new day.
• Additional Person(s) seen — Remember to bill for each additional patient seen after you’ve billed your first patient, in chronological order – maxes out depending on department and time. (see schedule below)

Special Visit Premiums are department-specific, so they can be used by any specialty:

• Emergency Department
• Hospital Out-Patient Department
• Hospital In-Patient
• Long-Term Care Institution
• Emergency Department by Emergency Department Physician
• Special Visits to Patient’s Home (other than Long-Term Care Institution)
• Palliative Care Home Visit
• Physician Office
• Other (non-professional setting not listed)
• Geriatric Home Visit
• Obstetrical Delivery with Sacrifice of Office Hours

*Bolded are commonly used SVP’s tables. See all Special Visit Premium tables here: http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physserv/sob_master20160401.pdf#page=60

When you are providing a special visit service, proper documentation should be recorded:

• 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

Special Visit Premium Examples:

Example 1 – being called in from home.

Dr. Apple is called in to attend an ER consult on Friday at 12pm. He will bill:

Patient 1 A130 – consultation K960 – travel premium – $36.40 K990 – first emergency patient seen – $20

He is then asked to consult on another patient while there, he bills:

Patient 2 A130 – consultation K991 – additional emergency patients – $20

Tip  If Dr. Apple admits either patient, he can also add the E082 Admission Premium to these claims.

*Please note: each Special Visit Premium has a limited number of use, highlighted in red

Example 2 – Being called from within the hospital:

Dr. Apple gets called to consult on an in-patient. This is a first consult outside of his normal schedule of the day and the time is now 8pm. He will bill an A code from his General Listings:

Patient 1 A435 – consultation C994 – first patient seen: evening – $60

* A travel premium is not applicable in this instance, as he is travelling within the hospital.

For more information on Special Visit Premiums, visit the OHIP Fee Schedule: http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physserv/sob_master20160401.pdf#page=60

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OHIP Schedule of Benefits and fees

Get the latest Schedules of Benefits for OHIP covered services.

This page is intended for health care providers. Learn more about services covered by OHIP .

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The information contained in the OHIP Schedule of Benefits requires knowledgeable interpretation and is intended primarily for members of the professional health care community. The Schedules set out the fees and requirements for payment for insured services under OHIP .

The OHIP Schedule of Benefits is not available in French or in alternative formats.

Schedule of Benefits for Physician Services

Physician Services Under the Health Insurance Act ( PDF ) - to February 20, 2024 (effective April 1, 2024)

• Amendments regarding Emergency Department Diagnostics to the Schedule of Benefits under the Health Insurance Act  ( PDF ) - April 1, 2005

OHIP Physician Fee Schedule Master

These files are intended for use with billing software.

The Physician Fee Schedule Master below is effective April 1, 2024.

If your billing software has not been updated by your vendor, you are encouraged to do so at your earliest convenience.

Please direct technical inquiries to your billing package developer or vendor.

• Text format
• OHIP  Physician Fee Schedule Master Record Layout  ( PDF )

Schedule of Benefits for Optometry Services

Optometry Services Under the Health Insurance Act ( PDF ) - March 11, 2023 (effective September 1, 2023)

OHIP Optometry Fee Schedule Master

The Optometry Fee Schedule Master below is effective September 1, 2023.

• OHIP Optometry Fee Schedule Master Record Layout ( PDF )

Schedule of Benefits for Dental Services

Dental Services Under the Health Insurance Act ( PDF ) - October 15, 2021 (effective November 5, 2021)

• Master Numbering System  ( CIHI Institution Numbers) - April 1, 2013

Schedule of Benefits for Laboratory Services

Laboratory Services Under the Health Insurance Act ( PDF ) - July 5, 2023 (effective July 24, 2023)

• Postal Code Classifications for L700, L777, L778, and L779

Schedule of Facility Costs for Integrated Community Health Services Centres

Schedule of Facility Costs for Community Surgical and Diagnostic Centres ( PDF ) - May 14, 2024

For more information, call ServiceOntario, INFOline at:

• Toll-free: 1-866-532-3161  (toll-free)
• TTY : 1-800-387-5559  (TTY)
• 416-314-5518  (in Toronto)
• TTY : 416-327-4282  (in Toronto)

General Surgery OHIP Billing Cheat Sheet

• General Surgery Procedures 
• Consultations & Assessments
• General Surgery Premiums 
• Admission Assessment by the Most Responsible Physician (MRP) Premium
• Intensive or Coronary Care Unit Premium 
• Surgical Procedure Premiums
• Physician Office
• Hospital Out-Patient Department
• Emergency Department
• Hospital In-Patient
• Non-Emergency Hospital in-patient Services
• Subsequent Visits
• Subsequent Visits by the Most Responsible Physician (MRP)
• Subsequent visits by the MRP following transfer from an Intensive Care Area

As a general surgeon submitting claims to OHIP is an important part of your job as not only does it help OHIP keep a record of procedures being done – it’s also how you get paid. Unfortunately, knowing which codes to use – or what premiums are allowed – is a time-sucking task that creates more admin work on your already busy workload. The best way to know what to bill is to familiarize yourself with the most common codes. We’ve put together an OHIP General Surgery Fee Code guide that will help you understand basic general surgery rules as well as common procedures. 

General Surgery Procedures 

Unlike other specialties, general surgeons bill for a variety of different procedures that fall under different specialties, sub-specialties or surgeries. This means each surgeon’s fee codes will depend on the diagnosis of your patient and why you’re seeing them. That being said, after you complete a procedure you’d head to the ER to consult or assess your patient. Consultations, assessments and follow-ups are all common procedures that qualify for extra adds on. You should get familiar with these since pre-op and post-op most of your claims will include these fee codes. If you need help looking up a procedure fee code consult our OHIP database under ‘ OHIP Surgical Procedures ’ Integumentary system surgical procedures

Musculoskeletal system surgical procedures

Respiratory surgical procedures

Cardiovascular surgical procedures

Haematic and lymphatic surgical procedures

Digestive system surgical procedures

Urogenital and urinary surgical procedures

Male genital surgical procedures

Female genital surgical procedures

Endocrine surgical procedures

Neurological surgical procedures

Ocular and aural surgical procedures

Spinal surgical procedures

For the consultations and assessments you’ll do on a daily basis reference the following fee codes and tips: 

General Surgery consultations are allowed once per 12-month period. All types of consultations (as outlined below) need to have been referred to you by a physician or nurse practitioner. 

A035 Consultation 

A935 Special surgical consultation

A036 Repeat consultation

A033 Specific assessment

A034 Partial assessment

K013 Individual counselling (Special Visit Premiums are not applicable to counselling codes)

• Individual and group counselling services are limited to 3 units per patient per physician per year at the higher fee (K013 individual code or K040 group code respectively); the amount payable for services rendered in excess of this limit will be adjusted to a lesser fee (K033 or K041 respectively).

General Surgery Premiums 

You can add Special Visit Premiums (SVP) to all Consultations & Assessments that have prefix ‘A’; please see Special Visit Premium tables below for more details. 

E082 Admission assessment by the MRP. It adds 30% to any of the above consultations or assessments with prefix ‘A’.

• E082 is only eligible for payment once per patient per hospital admission
• E082 is not applicable for any consultation or assessment related to day surgery

Intensive or Coronary Care Unit Premium 

If you visit a patient in the ICU or CCU you can add the intensive care premium (C101) to your claim. It is a flat fee of $9.10. C101 For each patient seen on a visit to ICU or CCU

• C101 is not eligible for payment with Supportive Care or with Critical Care, Ventilatory Care, Comprehensive Care, Acquired Brain Injury Management or Neonatal Intensive Care where team fees are claimed.
• C101 is also payable alone when no other separate fee is payable for the service provided in the ICU or CCU (e.g. post-operative care by surgeon).

You can apply surgical premiums to your Surgical Procedure codes if your working on weekends or after office hours. 

E409 Evenings (17:00h – 24:00h) Monday to Friday or daytime and evenings on Saturdays, Sundays, Holidays – increase the procedural fee(s) by 50% 

E410 Nights (00:00h – 07:00h) – increase the procedural fee(s) by 75%. 

For physician office visits , leave the service location and facility fields empty. Special Visit Premiums (SVP) usually do not apply to office visits as these visits are pre booked. However, you can still use Special Visit Premiums for office appointments.

For outpatient clinic visits at the hospital, set the service location code to HOP and the facility to the hospital Ambulatory Care number. Use any applicable Special Visit Premiums (SVP) from the Hospital Out-Patient Department Table below. The prefix for Out-Patient SVPs is ‘U’.

For emergency department visits , set the service location code to HED and the facility to the hospital Acute Care number. Use any applicable Special Visit Premiums (SVP) from the Emergency Department Table. The prefix for Emergency Department SVPs is ‘K’.

For emergency calls and other special visits to in-patients (Consultation & Assessments), set the service location code to HIP and the facility number to the hospital Acute Care. Use any applicable Special Visit Premiums (SVP) from the Hospital In-Patient Table. The prefix for Hospital In-Patient SVPs is ‘C’. (SVPs cannot be applied to Non-Emergency hospital In-Patient Services such as subsequent visits and prebooked inpatient Consultation & Assessments) .

If you see a patient in the hospital, in a non-emergency setting, you can use any of the fee codes below. Since these appointments are pre-booked (as there isn’t an emergency to see the patient) special visit premiums don’t apply. 

C035 Consultation

C935 Special surgical consultation

C036 Repeat consultation

C033  Specific assessment

C034 Specific re-assessment

You can use subsequent visit fee codes for any post-op in-patient visits.

C032 First five weeks

C037 Sixth to thirteenth week inclusive (maximum 3 per patient per week) per visit

C039 After the thirteenth week (maximum 6 per patient per month) per visit

If your the MRP for any non-surgical in-patients, or a patient pre-surgery that you have admitted, use the following codes: 

C122 Day following the hospital admission assessment

C123 Second day following the hospital assessment

C124 Day of discharge (day of discharge can be billed with post-op or non-surgical patients post 48 hours of hospital admission). 

C142 First subsequent visit by the MRP following transfer from an Intensive Care Area

C143 Second subsequent visit by the MRP following transfer from an Intensive Care Area

C121 Additional visits due to intercurrent illness

C038 Concurrent care

C982 Palliative care

Looking to maximize your billing?

Check out our General Surgery Billing Guide for more tips, tricks and automated features!

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.

Related posts:

Family practice and practice in general ohip fee code guide.

• OHIP Assessments and Consultation Guidelines
• 3 Ways to Optimize Your OHIP Medical Billing

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It’s business as usual and you’ll still be using the same product you’ve come to know and trust for your medical billing. Click here to sign in to your MDBilling.ca account as you normally would.

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Special Visit Premiums for Holidays

January 8th, 2015 OHIP Billing Codes C963 , C986 , C987 , K963 , K998 , K999 , OHIP Schedule of Benefits , Special Visit Premiums

According to GP3 in the Schedule of Benefits , the following are defined as ‘Holidays’:

Applying your Holiday Special Visit Premiums

What does this mean in practice?  Well in 2014, Dec 25 fell on a Thursday.  Thus a specialist called to see a patient on an urgent basis on the ward at 2:00pm could bill C987 ($75.00) instead of C991 ($20.00) with their assessment code.

On New Year’s Day, an internist called to the Emergency Department at 11:30pm could bill K998 ($75.00) with their travel premium K963 instead of the evening premium K994 ($60.00) with K962.  In other words, holiday premiums are more lucrative than the usual daytime ($20.00) or evening ($60.00) special visit premiums, but not the night-time premiums ($100.00).

For more on how to bill these premiums, see our blog on Special Visit Premiums .

Learn how to bill the Percentage Premium E078

Want to know how to maximize your Ontario Billing? Check out our Ultimate OHIP Billing Guide .

What is E078?

​ E078 is the premium fee code for Chronic Disease Assessment. OHIP first added this premium  to the Schedule of Benefits back in 2005. The idea behind it was to reimburse doctors who work with chronic disease, as it typically requires more out-patient follow up and overall care and management.     ​

How does it work?    

E078 is only payable on certain out-patient assessments and is a percentage-based premium. This means you need to add it to another code in order for it to work. It will then apply 50% to the assessment code you’ve added it to. ​  For example, let’s say you bill A263 (Medical Specific Assessment) which is $77.70. By adding E078 , you’ll get an extra 50%, which will bring the entire assessment to $116.55 (meaning the premium added an extra $38.85). ​

Who can bill E078?      

Of course, there are some restrictions when using it; such as location, specialty, and diagnostic code. For instance, it can only be added as a premium to out-patient assessments only. It’s therefore not applicable for any admitted inpatients, long-term care facility patients or patients in the emergency department. ​  It’s only eligible under the following specialties: ​ ​ Geriatrics Endocrinology & Metabolism Neurology Pediatrics Pathology Physical Medicine Therapeutic Radiology Medical Oncology Infectious Disease Respiratory Disease Rheumatology Hematology Clinical Immunology ​ ​ Additionally, in order to use E078 , you have to use it with one of the following diagnostic codes: ​ ​ 042  -  AIDS ​ 043  -  AIDS-related complex ​ 044  -  Other human immunodeficiency virus infection ​ 250  -  Diabetes mellitus, including complications ​ 286  -  Coagulation defects (e.g. haemophilia, other factor deficiencies) ​ 287  -  Purpura, thrombocytopenia, other hemorrhagic conditions ​ 290  -   Senile dementia, presenile dementia ​ 299  -  Child psychoses or autism ​ 313  -  Behavioural disorders of childhood and adolescence ​ 315  -   Specified delays in development (e.g. dyslexia, dyslalia, motor retardation) ​ 332  -  Parkinson's Disease ​ 340  - Multiple Sclerosis ​ 343  - Cerebral Palsy ​ 345  - Epilepsy ​ 402  - Hypertensive Heart Disease ​ 428  - Congestive Heart Failure ​ 491  - Chronic Bronchitis ​ 492  - Emphysema ​ 493  - Asthma, Allergic Bronchitis ​ 515  - Pulmonary Fibrosis ​ 555  - Regional Enteritis, Crohn's Disease ​ 556  - Ulcerative Colitis ​ 571  - Cirrhosis of the Liver ​ 585  - Chronic Renal Failure, Uremia ​ 710  - Disseminated Lupus Erythaematosus, Generalized Scleroderma, Dermatomyositis ​ 714  - Rheumatoid Arthritis, Still's Disease ​ 720  - Ankylosing Spondylitis ​ 721  - Other seronegative spondyloarthropathies ​ 758  - Chromosomal Anomalies ​ 765  - Prematurity, low-birthweight infant ​ 902  - Educational problems ​

How to Bill E078 on Dr. Bill

Billing E078 on your iPhone is easy, just follow these steps: 

Click on “All Patients” and select your patient (Use a Label Snap if it’s a new patient).  

Click on “New Claim” on the bottom left hand corner.

3. Click on the arrow for “Billing Code.” 4. Select your Assessment Code (our example is A263) and then the premium E078A. 

5. Fill out the rest of the claim as normal (Diagnoses, Location, Facility #, etc.) Click Save. 6. This will bring you to a “Confirmation” page, click “save” again. 

And You’re Done! 

Now if you go back to the home page and click on “Claims” you should be able to see the assessment code with the premium below it.