ohip-special-visit-premiums-k990-k991-k994-k995-k998-k999-k996-k997-travel-k960-2025-03-19 OHIP Special Visit Premiums (K-Codes) — Quick Lookup What must be documented to bill Special Visit Premiums?

OHIP Special Visit Premiums — Quick Lookup (K990/K991/K994/K995/K998/K999/K996/K997 + Travel Premiums)

Summary / Description: One-screen quick lookup for OHIP Special Visit Premiums using K-codes (first person seen + additional persons seen) and Travel Premiums by time period. Includes the max-per-time-period rules and required chart documentation notes.

OHIP Special Visit Premiums (K-Codes) — Quick Lookup

What must be documented to bill Special Visit Premiums?

Special Visit Premiums are only eligible for payment when the required time documentation rules are met in the medical record (the SoB lists documentation requirements by table).

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What assessment code do I submit with a Special Visit Premium?

Submit the claim using the appropriate A-prefix assessment fee from the General Listings when an assessment is rendered with a Special Visit Premium.

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Quick Lookup Table (Time period → Code → Fee → Max rule)

Important note for ED settings: Special Visit Premium Table I is marked “Not eligible for payment to Emergency Department Physicians” (see definition GP67).

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Time periods used in Table I (K-codes):

  • Weekdays Daytime (07:00–17:00)

  • Weekdays Daytime (07:00–17:00) with Sacrifice of Office Hours

  • Evenings (17:00–24:00) Monday–Friday

  • Sat., Sun. & Holidays (07:00–24:00)

  • Nights (00:00–07:00)

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One-screen table

Time periodTravel PremiumFirst Person SeenAdditional Person(s) Seen
Weekdays Daytime (07:00–17:00)K960 — $36.40 — max 2 / time period

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K990 — $20.00 — max 10 total (first + additional) / time period

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K991 — $20.00 — max 10 total (first + additional) / time period

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Weekdays Daytime (07:00–17:00) with Sacrifice of Office HoursK961 — $36.40 — max 2 / time period

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K992 — $40.00 — max 10 total (first + additional) / time period

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K993 — $40.00 — max 10 total (first + additional) / time period

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Evenings (17:00–24:00) Mon–FriK962 — $36.40 — max 2 / time period

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K994 — $60.00 — max 10 total (first + additional) / time period

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K995 — $60.00 — max 10 total (first + additional) / time period

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Sat., Sun. & Holidays (07:00–24:00)K963 — $36.40 — max 6 / time period

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K998 — $75.00 — max 20 total (first + additional) / time period

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K999 — $75.00 — max 20 total (first + additional) / time period

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Nights (00:00–07:00)K964 — $36.40 — no max / time period

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K996 — $100.00 — no max / time period

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K997 — $100.00 — no max / time period

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Zia-friendly reminders (short rules)

  • The “max” limits for K990/K991, K994/K995, and K998/K999 are combined totals of first + additional persons seen per time period.

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  • Travel Premium uses K960/K961/K962/K963/K964 depending on the time window, with its own max per time period (or no max at night).

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  • The time of the special visit must be documented to meet eligibility requirements (per SoB requirements).

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