Q998 – First person seen - Special Visit Premium - Nights
OHIP Critical Care Code — GENERAL PREAMBLE · Schedule of Benefits
This premium is payable for the first person seen during a special visit to a location that qualifies as an 'Other (non-professional setting not listed)' as per . It is applicable for non-elective services commenced on Saturdays, Sundays, and Holidays between 07:00 and 24:00. 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 (). This premium must be claimed in conjunction with an appropriate 'A' prefix assessment fee from the General Listings ().
When to Use
- Use Q998 when you are called to a patient's home or a nursing home on a weekend or holiday for an urgent, non-elective assessment.
- Apply this code when the service is initiated by the patient or their representative, distinguishing it from routine scheduled visits.
- Use this for the first patient seen during a trip to a non-professional setting, provided the service is non-elective.
Common Pitfalls
- Billing Q998 for services provided in an Emergency Department, which is strictly prohibited as those locations require Table I premiums like Q012.
- Claiming Q998 for elective services in a nursing home, as the non-elective requirement remains mandatory for all locations except the patient's private residence.
- Failing to document the exact time the service commenced, which is a mandatory audit requirement for all special visit premiums.
Billing Tips
- Always pair Q998 with an A-prefix assessment code (e.g., A007) to ensure the claim is processed correctly under the General Listings.
- If you see multiple patients during the same special visit trip, use Q998 for the first patient and the appropriate 'subsequent' premium (e.g., Q999) for additional patients.
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 ().
This premium is for the first person seen.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.