Special Visit Premiums

What are special visit premiums?

Special Visit Premiums are billed in addition to a special visit that requires the physician to assess a patient in response to a request initiated by the patient or a person caring for the patient (non-elective visit) or physician-initiated visit to a patient’s home (elective visit), provided the patient’s home is not a long term care facility, including a nursing home or home for the aged.

How to bill special visit premiums?

Submit claim using an “A” prefix assessment when an assessment is rendered in conjunction
with a special visit premium. You cannot bill a "C" prefix assessment with special visit premiums. Here is the fast and hard rule:
Axxx + Kxxx for Outpatient assessment/consult + special visit
Axxx + Cxxx for Inpatient assessment/consult + special visit

Information regarding when special visit premiums are payable is found on the OHIP Schedule of Benefits, pages GP65 to GP78 of the General Preamble.

Learn more about Special Visit Premiums on our OHIP billing tutorial for internal medicine.