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Billing code

A998A — Weekend/holiday office special visit premium, first patient

Weekend office first-patient premium

Bill A998 for the first patient seen at the office on a non-elective call, Saturday, Sunday or holiday, 07:00 to 24:00.

Watch for: Not payable during a scheduled weekend clinic or with A888; bill it with an A-prefix assessment on the same claim.

Code

A998A

Description

Weekend/holiday office special visit premium, first patient

FHO+ basket

Covered by the FHO+ base rate payment for enrolled patients, and shadow billed at 30% (50% for Schedule 2B procedures).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Office special visit premium for the first patient seen on a non-elective call on a Saturday, Sunday or holiday, 07:00 to 24:00.

What it covers

A998 is the 'first person seen' premium in Special Visit Premium Table VIII, Physician Office, for Saturdays, Sundays and holidays, 07:00 to 24:00 (GP76). Holidays are defined on GP3.

It pays for coming to the office outside regular hours for a patient's non-elective problem. On a weekend or holiday, the first person seen premium doesn't depend on a travel premium (GP66).

Billing rules

• Maximum one per time period (GP76).
• A special visit is one initiated by the patient, or someone on their behalf, for a non-elective service (GP65).
• Not payable when the office is scheduled to be open for patients at that time, such as a scheduled weekend clinic (GP65).
• Not payable for patients who come in without an appointment while the physician is there, or who are seen just before, during or just after regular office hours, even if those hours are at night or on a weekend (GP65).
• Bill the A-prefix assessment from the General Listings with the premium, and record the time of the visit (GP69).
• Not payable with A888 or with H-prefix emergency department codes (GP3, GP65).
• FHO: A998A is a Schedule 2 core service, in basket (Agreement p.75).

Often billed with

• The A-prefix assessment for the patient, such as A007, A003 or A001 (GP69).
• A963 travel premium (maximum one per time period) when the physician travels to the office for the call (GP76).
• Q012A, the patient enrolment model after-hours premium (FHO, FHN, FHG and others), is for enrolled patients seen in regularly scheduled after-hours sessions (OMA Q-codes guide p.8). A special visit premium isn't payable where the office is scheduled to be open, or for patients seen during routine office hours even on weekends (GP65), so the two don't normally fit the same visit.

Common rejections

• ADF: OHIP's description is 'required related procedure missing, invalid or paid at zero'. A special visit premium is only paid with an A-prefix assessment on the same claim (GP69), so check that the assessment is there and payable.

Related codes: A963, A990, A994, A996, A007, Q012

Source: Schedule of Benefits (July 1, 2026), General Preamble, Special Visit Premiums, pages GP65 to GP69 and Table VIII on GP76; holiday definition GP3

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