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Q016A
Q016A – CCM after-hours fee
OHIP Critical Care Code — APPENDIX Q · Schedule of Benefits
The Q016A fee provides a 30% increase for after-hours services rendered to patients under the Comprehensive Care Model (CCM). As specified on , this also applies as a '30% of virtual fee paid' for eligible comprehensive virtual care services. The eligible models listed are CCM (, ).
When to Use
- Use Q016A to claim a 30% premium on eligible CCM visit codes (e.g., A007A, A001A) when the service is provided during designated after-hours periods as defined in the Schedule of Benefits.
- Apply Q016A to eligible virtual care codes when the patient is enrolled in the CCM and the service occurs outside of core business hours.
Common Pitfalls
- Billing Q016A for services provided by a physician who is not registered under the CCM model, which will result in an automatic rejection.
- Attempting to stack Q016A with other after-hours premiums like Q012A or Q017A, which is prohibited as these are mutually exclusive premiums.
Billing Tips
- Ensure the service code being claimed is eligible for the CCM premium; Q016A is a percentage-based add-on that must be submitted on the same claim as the primary service code.
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