ONTARIO · ARTICLE
The four SVP families, the A-code conversion rule, time blocks, travel and patient premiums, and the combinations OHIP rejects, with four worked scenarios.
By Robin, Expert Biller, ResolvMD · 8-minute read
Special Visit Premiums (SVPs) compensate physicians for being called in on an unscheduled basis: outside a regular shift, after hours, or to a location they weren’t already at. They’re a legitimate and significant source of revenue, and they’re consistently underclaimed. The codes are specific, the time blocks are exacting, and the combinations OHIP accepts are narrower than most physicians assume.
This guide covers all four SVP families, the A-code conversion rule, time blocks, how travel and patient premiums work together, and where rejections most often happen.
Quick reference: the four SVP families
| Family | Use it when | Example codes |
|---|---|---|
| K codes | You’re called in to the ER on an urgent or emergent basis, and you’re not on call and not scheduled that shift | K960 travel · K990 first patient · K991 additional |
| H codes | You’re an ER physician on call for a shift, or called in early to start one | H962 travel · H984 first patient · H985 additional |
| C codes | You’re called to see an admitted inpatient with an unexpected issue (including day surgery on admitted patients) | C960 travel · C990 first patient · C987 additional |
| U codes | You’re called unexpectedly to a hospital outpatient department for non-elective care | U960 travel · U990 first patient · U991 additional |
The A-code conversion rule
All four SVP families must be billed with A-prefix visit codes. In an ER setting where you’d normally use H-prefix visit codes, convert to the A equivalent before billing the SVP.
| H code | A equivalent |
|---|---|
| H1*1 | A001 |
| H1*2 | A003 |
| H1*3 | A007 |
| H1*4 | A004 |
| H065 / H055 | A005 |
The same logic applies to C codes. For example, an orthopaedic surgeon called at 10:00 a.m. to see an inpatient who has fallen and fractured something bills A065 (not C065), with C960 (travel) and C990 (first patient seen). If there’s no exact A equivalent (C**2, for example), use the next closest code, A**3 or A**4. Billing all three as C-prefix codes is rejected.
Time blocks
| Period | Days | Hours |
|---|---|---|
| Daytime | Monday to Friday | 07:00 to 17:00 |
| Evenings | Monday to Friday | 17:00 to 24:00 |
| Weekends and holidays | Saturday, Sunday, holidays | 07:00 to 24:00 |
| Nights | Every day | 00:00 to 07:00 |
The SVP code you bill must match the time block in which you arrived on site, not when you finished. Billing the wrong block is the most common SVP rejection.
Weekday daytime call-ins that pull you away from a scheduled office session have their own “sacrifice of office” codes (for example, K961, K992 and K993).
Travel, first patient, and additional patients
Within each family and time block, you can bill three kinds of premium:
- Travel: when you physically travel to the hospital to provide the service.
- First patient seen: for the first patient you assess on that call-in.
- Additional patients: for each patient after the first, up to the maximum for that code.
Travel is generally limited to two premiums per day, with exceptions in some special circumstances, such as long-term care home visits.
To bill a second travel premium, you must have physically left the hospital and returned. The Ministry typically asks for documentation when more than one travel premium is billed in a day.
Restarting the clock (K and H codes)
With K or H SVP codes, you can restart the clock when your service crosses into a new time block. If you started seeing patients in the evening block and continued into the night block, you bill the appropriate premium for each block.
The exception: once your scheduled shift begins, you can no longer bill SVPs for that period. H-code SVPs cover the call-in or early start, not the scheduled shift itself.
Why SVPs get rejected
| Error | Example | Fix |
|---|---|---|
| Wrong time block | K999 (additional patient, weekends and holidays) billed on a Monday morning | Use K991 (additional patient, weekdays 07:00 to 17:00) |
| Wrong combination | K960 (travel) billed with K991 (additional patient) | Travel pairs with K990 (first patient seen) |
| Limit exceeded | K991 billed for an 11th patient | K991 covers up to 9 additional patients, 10 in total with K990 |
What counts as a holiday
The holiday definition for SVPs differs for ER and non-ER physicians.
Non-ER physicians. Family Day, Good Friday, Victoria Day, Canada Day, Civic Holiday, Labour Day, Thanksgiving, Christmas Day, Boxing Day and New Year’s Day.
If a holiday falls on a weekend, you may recognize either the preceding Friday or the following Monday.
- Boxing Day on a Saturday: the following Monday is recognized.
- Christmas Day on a Sunday: the preceding Friday is the holiday. On a Saturday: both the preceding Friday and the following Monday are recognized.
ER physicians. New Year’s Day, Family Day, Good Friday, Victoria Day, Canada Day, Civic Holiday, Labour Day, Thanksgiving, and December 25 to 31 inclusive.
- Christmas Day on a Saturday or Sunday: the preceding Friday is the holiday.
- New Year’s Day on a weekend: the following Monday is recognized.
- Canada Day on a Saturday or Sunday: you may recognize either the preceding Friday or the following Monday.
Four scenarios
Official sources
Call-ins billed correctly, every time
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