E080 – First visit after hospital discharge premium
OHIP Surgical Assists Code — GENERAL PREAMBLE · Schedule of Benefits
A premium payable for the first visit by a patient's primary care physician within two weeks of discharge from an acute care hospital. This visit must take place in the physician's office or the patient's home. It is not payable for admissions for obstetrical delivery (unless the mother required admission to an ICU), newborn care (unless the infant was in NICU), or for day surgery. This premium must be rendered with a qualifying assessment or counselling service, as listed in payment rule 5 on .
When to Use
- Use E080 when conducting a follow-up assessment (e.g., A007) for a patient discharged from an acute care hospital within the preceding 14 days.
- Apply this premium during a home visit (e.g., A900) for a frail patient who was recently discharged from an acute care facility, provided the visit occurs within the two-week window.
Common Pitfalls
- Billing E080 for patients discharged from day surgery or routine obstetrical deliveries, which are explicitly excluded by the Schedule of Benefits.
- Submitting E080 for visits occurring in a Long-Term Care home or retirement home, as the premium is strictly limited to office or patient home settings.
- Claiming E080 when the primary service code is not on the approved list, such as using it with a K035 instead of the permitted K030 or K032.
Billing Tips
- Ensure your EMR note clearly documents the hospital discharge date to justify the premium during a potential audit.
- Verify that the primary service code attached to E080 is one of the eligible codes listed in payment rule 5 of GP28, as incorrect pairing will trigger an automatic rejection.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Other Premiums (including After Hours Procedure Premiums)
1. Subject to payment rules 2 through 5, E080 is only eligible for payment for a visit with the patient's primary care physician in the physician's office or the patient's home within two weeks of discharge following in-patient admission to an acute care hospital.
2. E080 is not eligible for payment if the admission to hospital was for the purpose of obstetrical delivery unless the mother required admission to an ICU during the hospital stay.
3. E080 is not eligible for payment if the admission to hospital was for the purpose of newborn care unless the infant required admission to a NICU during the hospital stay.
4. E080 is not eligible for payment if the admission to hospital was for the purpose of performing day surgery.
5. E080 is only eligible for payment when rendered with the following services: A001, A003, A004, A007, A008, A261, A262, A263, A264, A888, A900, K004–K008, K013, K014, K022, K023, K028-K030, K032, K033, K037, K623, P003, P004, P008.
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