OHIP Payments for Special Visit Premiums in Facilities

The purpose of this module is to provide a general overview of the payment rules for special visit premiums billed to OHIP.  This module focuses on payments for special visits that occur to patients in hospital, the emergency department and long-term care.

OHIP fee codes referred to in this module can be located via the numeric index of the current OHIP Schedule of Benefits for Physician Services (the “Schedule”):

For additional information on billing for special visits, refer to the OMA Quick Reference Guide – OHIP Payments for Special Visit Premiums

This Self-Learning program has been certified by the College of Family Physicians of Canada for up to 2 Mainpro+ credits.

This activity is an Accredited Self-Assessment Program (Section 3) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by the University of Ottawa’s Office of Continuing Professional Development. You may claim a maximum of 2.0 hours (credits are automatically calculated).

If you are having any issues with downloading your CME Certificate, please contact info@oma.org and it will be sent to you. Sorry for the inconvenience.

Faculty Disclosures

Disclaimer: This resource contains the views and opinions of the Ontario Medical Association (OMA) regarding the interpretation of the Ontario Health Insurance Plan (OHIP) Schedule of Benefits (Schedule). Members are advised that the ultimate authority in matters of interpretation and payment of insured services (as well as determination of what constitutes an uninsured service) are in the purview of the government via the General Manager of OHIP. The OMA assumes no responsibility for any discrepancies or differences of interpretation of the Schedule, any applicable law, or regulation with the Government of Ontario including but not limited to the Ministry of Health and Long-Term Care, and the College of Physicians and Surgeons of Ontario. Members are advised to contact their regional OHIP office to request written interpretations and any billing related information.

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Module 1 Payments for Special Visit Premiums  
Unit 1 Definition of a Special Visit Premium
Unit 2 Components of a Special Visit
Unit 3 Payment Requirements
Unit 4 Summary
Module 2 Test Your Knowledge  
Unit 1 Quiz Question #1
Unit 2 Quiz Question #2
Unit 3 Quiz Question #3
Unit 4 Quiz Question #4
Unit 5 Quiz Question #5
Unit 6 Quiz Question #6
Unit 7 Quiz Question #7
Unit 8 Quiz Question #8
Unit 9 Quiz Question #9
Module 3 Feedback  
Unit 1 Tell us what you think of this module