Special Visit Premiums

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 as compensation for certain types of work. They can significantly increase your monthly revenue, however they can only be used in conjunction with an appropriate A-prefix assessment or consultation fee, and on certain dates as per the Ministry of Health’s OHIP Fee Schedule.

For 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:

  • Time
  • Department
  • 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. Anderson is called in to attend some ER consults on Friday at 12pm. He will bill:

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

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

*Tip* If Dr. Anderson admits this patient he can also add the E082 Admission Premium to these claims

OHIP Fee Schedule Special Visit Premium Table I - Emergency Department

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

Example 2 – Being called from within the hospital:

Dr. Anderson gets called to consult on an in-patient, this is a first consult 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

OHIP Fee Schedule Special Visit Premium Table III - Hospital In-Patient

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

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