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. 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:

  • 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.

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. 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.

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