H985 – Additional person(s) seen
OHIP Obstetrics Code — GENERAL PREAMBLE · Schedule of Benefits
`H985` is a special visit premium of $60.00 for an additional person seen by a designated Emergency Department Physician. This premium is applicable for non-elective services that commence during evenings (17:00 to 24:00) Monday through Friday. According to , this premium is only payable when the physician is required to travel to the hospital for the special visit and is not already present at the hospital. It is claimed with an appropriate 'A' prefix assessment code, not an 'H' prefix code. A maximum of 5 total 'first person seen' and 'additional person seen' premiums are payable per physician during this time period.
When to Use
- Use H985 for the second and subsequent patients seen when you are called back to the ED for multiple patients during the evening shift (17:00-24:00).
- Apply this code when you have already claimed H984 for the first patient and are required to assess additional patients during the same call-back event.
Common Pitfalls
- Claiming H985 when you are already physically present in the hospital for other duties, which violates the requirement that you must be called back to the facility.
- Submitting H985 with an H-prefix assessment code instead of the required A-prefix assessment code from the General Listings.
- Exceeding the maximum of 5 total premiums (H984 plus H985) per physician during the designated evening time block.
Billing Tips
- Ensure the time of the request to attend is clearly documented in each patient's chart to substantiate the call-back nature of the visit.
- Always pair H985 with an A-prefix assessment code (e.g., A007) to ensure the claim is processed correctly under the General Listings.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table V - Emergency Department by Emergency Department Physician)
Definition of Emergency Department Physician: A physician working in a hospital emergency department or Hospital Urgent Care Clinic for unscheduled patients. For special visit premium eligibility, the physician must be on-call or requested to attend at a time when they are not otherwise scheduled to work, and must not be at the hospital when the request is made. (, ).
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