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Special Visit Premiums

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What is Special Visit Premium?

Special Visit Premium is 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

Question:

Can I bill a C-prefix special visit premium to my inpatient assessment (e.g. C133)?

Answer:

You cannot bill a Cxxx 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

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

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