A998 – First person seen
OHIP General Listings Code — GENERAL PREAMBLE · Schedule of Benefits
A special visit premium payable for the first person seen at a physician's office during Saturdays, Sundays, and Holidays between 07:00 and 24:00. The visit must be initiated by the patient or their representative for a non-elective service.
When to Use
- Bill A998 when you see the first patient in your office on a Saturday at 10:00 AM for a non-urgent follow-up appointment, provided it's not a scheduled 'open' clinic day.
- A998 is appropriate if you are the first patient seen in your office on a Sunday at 2:00 PM for a new patient consultation initiated by the patient.
- Use A998 for the first patient seen in your office on a statutory holiday at 11:00 AM for a condition requiring immediate attention, not an emergency department visit.
Common Pitfalls
- Claims are rejected if A998 is billed with 'H' prefix codes, as these are emergency department services.
- A998 will be denied if the patient's visit is scheduled during regular office hours, even if it falls on a weekend or holiday.
- Billing A998 for patients seen without an appointment during physician's presence in the office, even on a weekend, is incorrect.
Billing Tips
- Ensure the time of the special visit is clearly documented in the medical record to support the A998 claim.
- Submit A998 on the same claim as an eligible assessment code, such as an intermediate assessment (e.g., A007), not as a standalone service.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Special Visit Premium
Premium
For fee codes listed in Tables I, II, III, IV, VI, VII, VIII, IX and X the time at which the special visit takes place must be documented on the medical record.
Special visit premiums are only eligible for payment when rendered with certain services listed under 'Consultations and Visits' and 'Diagnostic and Therapeutic Procedures' sections of the Schedule.
Additional person premiums are not applicable in the Physician Office setting (Table VIII).
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