OHIP Special Visit Premiums Explained

Special visit premiums are the most structurally complicated part of the OHIP General Preamble, and the part physicians most often skip entirely. That is not because the money is small, but because the rules look risky. A single night-time premium is $102.80 to $113.10 on top of the assessment. Skipping ten of them a year is real money.

The system is actually regular once you see its shape: three variables (setting, time, and whether you travelled) determine everything. This post walks the whole grid.

If you want the broader survey of premiums family physicians miss (after-hours, post-discharge, MRP, chronic disease), that's a separate post. This one is only about special visits, and goes considerably deeper.

All fees below are from the current Schedule of Benefits, effective April 1, 2026.

What counts as a special visit

The Schedule's definition is precise: a special visit is a visit initiated by the patient, or by someone on the patient's behalf, for the purpose of rendering a non-elective service. If it is rendered in the patient's home, it can be a non-elective or elective service.

Two things follow from that. First, the visit has to be patient-initiated. Second, outside the home, it has to be non-elective. The home is the one setting where an elective visit still attracts a premium.

There's a second qualifying route that doesn't depend on the clock: sacrifice of office hours. The Schedule defines this as a service rendered when the patient's demands or condition are such that you make a previously unscheduled non-elective visit at a time when you had office visits booked, and because of that unscheduled visit, an office visit was delayed or cancelled. You left booked patients waiting to go see someone else. That qualifies on its own, in the middle of a Tuesday.

The two kinds of premium

Every special visit premium table has the same columns:

Travel premium: paid once per trip to a destination, regardless of how many patients you see there. It's payable only for travel from one location to another. It is explicitly not payable for travel within the same long-term care facility, within a hospital complex, or between buildings on the same hospital campus. Walking across the campus is not travel.

First person seen premium: the substantial one. Payable for the first patient you see at the destination, and eligible when:

1. the service commenced during an eligible time period (evenings 17:00–24:00 Monday to Friday; 07:00–24:00 on Saturday, Sunday or holidays; or nights 00:00–07:00), or
2. the service required sacrifice of office hours, or
3. the service was rendered during weekday daytime hours 07:00–17:00 in circumstances where a travel premium is eligible for payment.

Additional person seen premium: for subsequent patients at the same destination, at the same rate as the first-person premium. This one has a hard scope limit that catches people out: additional-person premiums are only payable in emergency departments, hospital outpatient departments, long-term care institutions, and for hospital inpatients. Not in a patient's home. Not in your office.

The time periods

The Schedule lays out every table in the same column order, and the fee ladder is consistent across most settings:

Note the ordering: sacrifice of office hours doubles the weekday daytime premium, but it is the lowest of the after-the-fact periods. An evening pays more, a weekend or holiday pays more again, and nights pay the most. Nights start at midnight every day, weekends included: a Saturday call at 02:00 is a night premium, not a weekend one.

Two tables have only four columns. Table V (emergency department physicians) and Table VIII (your own office) have no sacrifice-of-office-hours column.

The travel premium is $37.40 in every period and every setting. What changes between periods is the first-person and additional-person fee; what changes between settings is the code prefix and the daily maximums.

The setting decides the prefix

This is the single most useful thing to memorize:

Table I: Emergency department, non-ED physicians (K-codes)

You're called in to the ED but you are not the ED physician. Daily maximums in brackets.

The first-person maximums are totals for first and additional persons across the period: 10 per day for the weekday daytime, sacrifice and evening periods, 20 on weekends and holidays. Beyond those limits, the Schedule directs you to submit subsequent patients using the "H" prefix listings.

Table II: Hospital outpatient department (U-codes)

Identical fee structure and identical maximums, different prefix.

Table III: Hospital inpatients (C-codes)

Same fees, but note the Saturday, Sunday and holiday codes break the numbering pattern: they're C986 / C987, not C998/C999.

Important limitation on inpatient special visits generally: premiums are not payable for patients seen during rounds, and not payable with admission assessments for patients admitted electively. A special visit to a ward is a call-back, not a scheduled round.

Table IV: Long-term care institutions (W-codes)

Table IV follows the same column order as Tables I to III, so the W-codes line up one-for-one with their K-, U- and C-code equivalents (with the C986/C987 exception noted above).

Two traps here. Special visit premiums are not payable for elective services in a long-term care institution, including a nursing home or home for the aged, even though the facility is the patient's home. The home-visit exception for elective services does not extend to LTC. And travel within the same facility never qualifies for a travel premium, however far you walk.

Table V: Emergency department, by an ED physician (H-codes)

This table is for physicians who meet the Schedule's definition of an Emergency Department Physician: either scheduled to work in a hospital ED that day, requested by the ED to attend when not otherwise scheduled and not at the hospital when the request is made; or on-call on a scheduled basis specifically available to a hospital ED and not at the hospital when the request is made.

Table V has no sacrifice-of-office-hours column; it doesn't apply to this role.

Table I (the K-codes) is not payable to ED physicians. If you meet the definition, Table V is yours.

Table VI: Home visits (B-codes)

The home is the most distinctive table in the system, and the one with the most misbilling.

Note that home fees are higher than the base ladder in every period: $28.25 rather than $20.55, $113.10 rather than $102.80. And as in Table III, the weekend first-person code breaks the pattern: it's B993, not B998 (B998 belongs to the palliative table).

Four things to get right:

1. There are no additional-person premiums in the home. The first-person premium is payable once, regardless of how many patients you see during one visit to a home.
2. That extends to multiple resident dwellings. The Schedule defines a multiple resident dwelling as a single location where units share a common external entrance or lobby: an apartment block, retirement or rest home, commercial hotel, motel, boarding house, university or boarding school residence, hostel, correctional facility, or group home. Six patients in one apartment building is one premium, not six.
3. Daily maximums are combined. Two B960 per physician per day total, in any combination of elective and non-elective. Ten B990 per day, same rule.
4. Elective home visits still qualify, at the weekday daytime rate, whatever the day or time. The home is the only setting where that's true.

The A007 / A001 home visit trap

This is the one that causes the most incorrect claims, and it's stated explicitly in the Schedule:

Special visit premiums in Table VI are not eligible for payment with A007 or A001 when rendered in a patient's home.

For A007 and A001 rendered in the home, travelling to and from the home is treated as a common element of the insured service; it's already in the fee. Stacking a B-code onto a home-visit A007 is not a grey area; it will not pay. If you're billing home visits, you need to be using the home care assessment codes the Schedule intends for that setting, not an office assessment code with a premium bolted on.

Table VII: Palliative care home visits

Palliative home visits get their own table, and it's substantially better than Table VI: no daily maximums in any period.

Table VII has all five columns but only three codes: one travel code, B966, for every period; B998 for every period except nights; and B997 for nights.

$91.80 flat for the first patient in four of the five periods, uncapped. If you carry palliative patients in the community, this is the single highest-value table in the special visit system for a family physician.

Table VIII: Your own office (A-codes)

Coming back to the office to see someone who called you.

No sacrifice-of-office-hours column (you're in the office), no additional-person premiums, and a maximum of one per time period in every period except nights.

Table VIII is also the table most affected by the exclusion rules below. In particular, patients seen immediately before, during, or immediately after routine office hours don't qualify, even if those hours run into the evening or fall on a weekend.

Table IX: Other settings (Q-codes)

For a non-professional setting not covered by any other table.

Table IX uses the same column order as Tables I to IV, so the Q-codes line up with their K-, U- and W-code equivalents.

Table X: Geriatric home visits

Close to the palliative table, and built the same way: one travel code for every period, one first-person code for every period except nights, and a higher night code. All uncapped.

The restriction is who can bill it: Table X is payable only to a specialist in Geriatrics (specialty 07), or to a physician holding a Ministry of Health exemption to access-bonus impact in Care of the Elderly. It is not a general family practice table.

Also: obstetrical delivery with sacrifice of office hours

One code sits outside the main tables. C989: $78.55, maximum one per time period, payable for an obstetrical delivery requiring sacrifice of office hours. Every other period pays $0.00 for this listing. It's also the one exception to the rule that special visit premiums aren't payable for non-referred or non-transferred obstetrical patients.

When special visit premiums are never payable

Regardless of setting or time of day, the Schedule excludes premiums in these situations:

• Patients seen during rounds at a hospital or long-term care institution
• With admission assessments for patients admitted electively
• For non-referred or non-transferred obstetrical patients, except C989
• For services in a place, other than a hospital or LTC facility, that is scheduled to be open for diagnosing or treating patients
• For a visit where critical care team fees are payable
• With any sleep study service
• For patients who present to your office without an appointment while you're already there, or who are seen immediately before, during, or immediately after routine office hours, even if those hours are at night, on a weekend, or on a holiday
• With emergency department "H" prefix fee codes (the assessment listings, not the Table V premiums)

The through-line: a special visit premium compensates you for being pulled to a place you weren't already going. If you were going to be there anyway, it isn't a special visit.

How to submit

Submit the assessment itself using the appropriate A-prefix assessment fee from the General Listings, and add the special visit premium alongside it. The premium is a companion code, not a replacement for the visit. The claim needs the time the service started, because that is what places it in a period.

Practically, a weekday-evening call-back to see an inpatient looks like: the assessment code, plus C962 if you travelled, plus C994 for the first patient, plus C995 for each additional patient at that destination. On a Saturday, Sunday or holiday the same visit uses C963, C986 and C987 instead.

The pattern worth internalizing

Three questions answer almost every special visit premium:

1. Where was the patient? → prefix (K / U / C / W / H / B / A / Q)
2. When did the service start, and did you give up booked office hours? → period, and therefore fee
3. Did I travel to a different location, and was I the first patient seen there? → which columns you get

Then two checks: was it non-elective (or a home visit), and am I over the daily maximum?

That's the whole system. The reason it goes unbilled isn't complexity; it's that the answers depend on context that isn't written on the fee code and that nobody remembers at 11 p.m.

Where SnapBill fits

SnapBill checks every claim against the Schedule of Benefits before it's submitted. For special visits that means the time of service, the setting, and the codes you've entered are cross-checked against the premium tables. A home-visit A007 with a B-code attached, or a weekend code on a Tuesday evening, gets flagged before it goes out, not after it's rejected, and an eligible evening or weekend premium gets surfaced while you're still billing.

Each flag comes with a plain-language note explaining the rule, so the next time the same situation comes up you already know the answer.

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Fees verified against the OHIP Schedule of Benefits, effective April 1, 2026. Browse individual codes on our billing code pages, or sign up free and have your premiums checked automatically.