K998 – First Person Seen
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
A 'First Person Seen' premium payable for a non-elective special visit to a patient in an Emergency Department. This premium applies to services rendered on a Saturday, Sunday, or Holiday between 07:00 and 24:00. A special visit is defined as a visit initiated by a patient for a non-elective service (). This premium must be claimed with an appropriate 'A' prefix assessment code (). It is not eligible for payment to physicians who are defined as 'Emergency Department Physicians' (, ). The time of the visit must be documented in the medical record (). There is a maximum of 20 total 'first person seen' (K998) and 'additional person seen' (K999) premiums payable per physician during this time block.
When to Use
- Use K998 when you are a community-based physician called into the ED for a non-elective, urgent assessment on a weekend or holiday between 07:00 and 24:00.
- Apply this code when you perform the first assessment of a patient in the ED during the specified hours, provided you are not the physician assigned to the ED shift.
Common Pitfalls
- Billing K998 if you are the physician on-call for the Emergency Department, as this is explicitly excluded under GP67/GP70 definitions.
- Failing to include the exact time of the visit in the medical record, which is a mandatory requirement for audit compliance under GP69.
- Exceeding the combined cap of 20 premiums for K998 and K999 per physician within the designated time block.
Billing Tips
- Always pair K998 with an appropriate A-prefix assessment code (e.g., A007) to ensure the claim is processed as a valid special visit premium.
- Ensure your claim submission clearly reflects the non-elective nature of the visit to avoid rejection during automated OHIP validation.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table I - Emergency Department)
The time at which the special visit takes place must be documented on the medical record.
Not eligible for payment to Emergency Department Physicians (see definition ).
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