Q964 – Travel Premium - Sacrifice of Office Hours
OHIP Critical Care Code — GENERAL PREAMBLE · Schedule of Benefits
A travel premium for a special visit to an 'Other (non-professional setting not listed)'. This premium applies when the service requires sacrifice of office hours. A special visit is defined as a visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service. A travel premium is payable for travel from one location to another destination. It is not payable for travel within the same long-term care facility, hospital complex, or buildings on the same hospital campus. Only one travel premium is eligible for payment for each separate trip to a destination, regardless of the number of patients seen. The associated assessment must be claimed using an 'A' prefix fee code.
When to Use
- Use Q964 when you are called away from your office during scheduled hours to perform an urgent, non-elective assessment at a patient's private home.
- Apply this code when traveling to a non-professional setting, such as a school or workplace, for a non-elective visit that forces you to cancel or delay existing office appointments.
Common Pitfalls
- Claiming Q964 for a visit at a location that is already staffed or equipped for patient care, which violates the 'non-professional setting' requirement.
- Billing Q964 in addition to an 'H' prefix emergency department code, which is explicitly prohibited under the General Preamble.
- Attempting to claim multiple Q964 premiums when seeing multiple patients at the same location; only one travel premium is payable per trip.
Billing Tips
- Ensure the associated assessment is billed with an 'A' prefix code, as the premium is only valid when paired with a standard office-style assessment fee.
- Document the exact time of the visit and the fact that it was non-elective to justify the sacrifice of office hours during an audit.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table IX - Other non-professional setting)
The time at which the special visit takes place must be documented on the medical record.
Submit claims using the appropriate A-prefix assessment fee from the “General Listings” for an assessment rendered in conjunction with a special visit premium.
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