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.
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:
https://www.ontario.ca/files/2024-01/moh-ohip-schedule-of-benefits-2024-01-24.pdf#page=84
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. 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.
*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:
https://www.ontario.ca/files/2024-01/moh-ohip-schedule-of-benefits-2024-01-24.pdf#page=84