Q990 – First person seen
OHIP Critical Care Code — GENERAL PREAMBLE · Schedule of Benefits
A special visit premium for the first person seen at the destination for a non-elective service, as defined in SPECIAL VISIT PREMIUM TABLE IX - Other (non-professional setting not listed) on page of the Schedule of Benefits. This premium applies to services commenced during weekdays daytime hours (07:00-17:00). A special visit is a visit initiated by a patient or on behalf of the patient for a non-elective service (). The service must be rendered in a non-professional setting not otherwise listed in the Schedule. Claims must be submitted with an appropriate 'A' prefix assessment fee from the 'General Listings' ().
When to Use
- Use Q990 when you are called out to a non-professional setting, such as a patient's private residence or a workplace, for an urgent, non-elective assessment during weekday daytime hours.
- Apply this code when you must leave your office or home specifically to attend to a patient in a non-clinical environment, provided the visit is initiated by the patient or their representative.
Common Pitfalls
- Billing Q990 for patients seen in your office during regular hours is a common audit trigger; it is strictly prohibited for walk-ins or patients seen during scheduled office time.
- Submitting Q990 alongside an 'H' prefix emergency department code will result in an automatic rejection, as special visit premiums are not payable for ED-based services.
- Claiming Q990 for services rendered in a facility that is already open for patient care, such as a walk-in clinic or urgent care centre, is an invalid use of this premium.
Billing Tips
- Ensure your claim includes an 'A' prefix assessment code (e.g., A007) as the base service, as Q990 is a premium that cannot stand alone.
- Clearly document the exact time the visit commenced and the location of the service in the patient record to justify the 'special visit' status 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.
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