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Q091
Q091 – Primary care after-hours fee
OHIP Critical Care Code — APPENDIX Q · Schedule of Benefits
The Q091 is a premium paid in addition to an eligible comprehensive virtual care service when provided during after-hours. It increases the value of the virtual fee paid by 10%. This premium is only payable to physicians participating in specific eligible models: TPCA and GP Focused Palliative Care.
When to Use
- Use Q091 when performing a virtual assessment (e.g., A007A) for a patient enrolled in your TPCA or GP Focused Palliative Care model during designated after-hours time blocks.
- Apply this premium when the virtual service is initiated and completed outside of standard office hours, provided the primary service code is on the eligible list.
Common Pitfalls
- Billing Q091 with non-eligible service codes will result in automatic rejection; verify the primary service code is explicitly listed in the Appendix Q eligible codes.
- Attempting to claim Q091 while working in a non-participating model (e.g., FHO or FHN) will lead to claim adjustments, as this premium is restricted to specific models.
- Confusing Q091 with Q012A or Q017A; Q091 is specifically for virtual care, whereas the Q-series premiums for in-person visits have different eligibility and percentage rules.
Billing Tips
- Ensure your billing software is configured to automatically calculate the 10% premium based on the primary service fee to avoid manual calculation errors.
- Always confirm the patient's enrollment status in your TPCA or Palliative model before submission, as the premium is tied to the provider's model participation, not just the service type.
Percentage Premium: 0.1%
This code applies a percentage increase to the base procedure fee
Provider Fee$0.00
Effective: December 1, 2007
Category
AQ. Appendix Q
Subcategory
APPENDIX Q
Service Type
PercentageIncrease
Code Classes
Other Premiums (including After Hours Procedure Premiums), Virtual Care Services
Eligible Models: TPCA, GP Focused Palliative Care.
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