Q992 – First person seen
OHIP Critical Care Code — GENERAL PREAMBLE · Schedule of Benefits
This premium is for the first patient seen during a special visit to a location not otherwise specified in the Special Visit Premium Tables (i.e., not a hospital, office, or long-term care institution). It is payable when a physician is called for a non-elective service during weekday evening hours (17:00-24:00). This premium is claimed in addition to an appropriate A-prefix assessment code and any applicable travel premium.
When to Use
- Use Q992 when you are called to a patient's private residence for an urgent, non-elective assessment between 17:00 and 24:00 on a weekday.
- Apply this code when providing an urgent service at a location like a community center or workplace that does not fall under hospital or long-term care facility definitions.
Common Pitfalls
- Claiming Q992 for a visit to a hospital or long-term care facility, which instead requires the Q000-series or Q010-series premiums.
- Billing Q992 for elective services or routine follow-ups, as this premium is strictly reserved for non-elective, urgent clinical needs.
- Failing to include the exact time of the visit in the clinical note, which is a mandatory requirement for audit compliance under the General Preamble.
Billing Tips
- Always pair Q992 with the appropriate A-prefix assessment code (e.g., A007) and ensure the claim reflects the actual time of the service to justify the premium.
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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