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Q012A
Q012A – Primary care after-hours fee
OHIP Critical Care Code — APPENDIX Q · Schedule of Benefits
A premium providing a 30% increase on the fee for eligible after-hours services. For non-virtual services, it is available to physicians in FHG, FHN, FHO, RNPGA, BSM, GHC, SJHC, SEAMO, and WHA models. It is also payable as 30% of the virtual fee paid for eligible comprehensive virtual care services provided by physicians in FHO, FHN, FHG, GHC, BSM, RNPGA, SJHC, and WAHA models.
When to Use
- Apply Q012A to eligible office visits occurring on weekdays between 17:00 and 08:00, or on weekends and holidays, provided the patient was seen in the office.
- Use Q012A to claim the 30% premium on eligible virtual care codes when the service is provided by a physician in a participating FHO, FHN, or FHG model.
- Utilize Q012A for urgent care services provided outside of core hours that do not meet the specific criteria for the more restrictive Q016A or Q017A premiums.
Common Pitfalls
- Billing Q012A on the same service as Q016A or Q017A will result in a rejection, as these premiums are mutually exclusive.
- Attempting to claim Q012A for services provided during core office hours, even if the patient was seen as an 'add-on' or emergency, will trigger an audit flag.
- Failure to ensure the service code itself is eligible for the Q-code premium, as not all procedure or assessment codes qualify for the 30% uplift.
Billing Tips
- Ensure the start and end times of the service are clearly documented in the chart to justify the after-hours timing required for the Q012A claim.
- Verify your specific practice model's eligibility for virtual care Q012A, as the list of participating models can differ slightly from in-person eligibility.
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