Physician Payment and Policy Ontario Health Insurance Program
Resource Manual for Physicians
2.2   General Preamble (Continued)

Emergency Department - Emergency Physician on Duty

Emergency Department – Emergency Physician on Duty : There are specific listings “H” prefix (H1-codes) for consultations, multiple systems assessments, minor assessments and re-assessments rendered by the physician on duty during regular and premium hours. Any physician on duty in the emergency department should claim these fees. These listings also apply to the services rendered by physicians who provide on-call emergency room coverage for designated periods of time and limit the services they provide, in the community served by the hospital, predominantly to emergency room coverage. When special visits are rendered by such physicians, codes with “A” prefix and the appropriate special visit premiums K99x - may be claimed for the first patient seen :

  • for a maximum of two special visits that commence after 08:00h and before 17:00h
  • for a maximum of three special visits after 17:00h and before 24:00h
  • for the number of special visits rendered after 00:00h and before 08:00h

An Emergency Physician not on Duty required to make a special visit to the Emergency Department would claim the appropriate “A” prefix code and the appropriate special visit premium K99x for the first patient assessed; all subsequent patients assessed would be claimed using the “H” prefix codes.

A physician on call for the Emergency Department would bill the initial special visit(s) (to a maximum of ten) using “A” codes and appropriate special visit premiums K99x.

If the physician on call is already in the hospital or environs a special visit premium cannot be billed when the physician is called to the Emergency Department.