Q996 – First person seen - Sacrifice of Office Hours
OHIP Critical Care Code — GENERAL PREAMBLE · Schedule of Benefits
The Q996 premium applies to the first person seen by a physician during a special visit to render a non-elective service in a non-professional setting not otherwise specified in the Schedule (see Special Visit Premium Table IX on page ). This premium is applicable when the physician makes a previously unscheduled non-elective visit, causing a delay or cancellation of a booked office visit (Sacrifice of Office Hours, as defined on page ). This premium is paid in addition to the fee for the accompanying assessment, which must be claimed using an A-prefix code. The time of the special visit must be documented in the medical record.
When to Use
- Use Q996 when you are called away from your office to perform an urgent, non-elective assessment at a location not covered by other specific premiums, such as a patient's home or a facility not listed in Table IX.
- Apply this code when the emergency call forces you to cancel or delay scheduled office patients, satisfying the 'Sacrifice of Office Hours' requirement.
Common Pitfalls
- Billing Q996 when the service is elective or pre-scheduled, as it is strictly intended for non-elective, unscheduled visits.
- Failing to document the exact time of the visit in the patient record, which is a mandatory audit requirement for all Table IX premiums.
- Attempting to claim Q996 alongside a travel premium (e.g., K960) without ensuring the location qualifies as an 'other' non-professional setting.
Billing Tips
- Always pair Q996 with an appropriate A-prefix assessment code (e.g., A007) to ensure the claim is processed correctly as a special visit.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table IX - Other non-professional setting)
For fee codes listed in Table IX, the time at which the special visit takes place must be documented on the medical record.
This premium is for 'Other (non-professional setting not listed)' as per Special Visit Premium Table IX.
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