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Billing code

Q016A — After-hours premium (CCM)

After-hours premium (CCM)

Comprehensive Care Model physicians add Q016A to eligible visits for enrolled patients seen in scheduled sessions after 5 pm weekdays, weekends or holidays.

Watch for: Never between 8 am and 5 pm, and not for patients seen late because the clinic is behind schedule.

Code

Q016A

Description

After-hours premium (CCM)

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Explanation

Updated October 26, 2026

CCM after-hours premium code added to eligible visits for enrolled patients seen in scheduled evening, weekend or holiday sessions.

What it covers

Q016A is the after-hours premium for physicians in the Comprehensive Care Model (CCM) (AQ2). It has no fee of its own. It tells OHIP to pay a percentage premium on the eligible visit codes on the claim for an enrolled patient. Physicians in FHG, FHN, FHO and the other listed models use Q012A instead (AQ2).

Appendix Q is for information only and is not part of the Schedule (AQ1). The billing rules come from the 2020 OMA Q-codes guide. The April 2026 FHO agreement does not apply to CCM.

Billing rules

• Premium of 30% on the eligible codes (AQ2; OMA Q-codes guide p.8).
• Eligible base codes: A001, A003, A004, A007, A008, A888, E089, K005, K013, K017, K030, K033, K130, K131, K132 and Q050 (OMA Q-codes guide p.8; INFOBulletin 260316).
• Q016A must be on the claim for the premium to be paid (OMA Q-codes guide p.8).
• Only for enrolled patients seen in regularly scheduled after-hours sessions: after 5 pm on weekdays, or any time on weekends and statutory holidays. Never between 8 am and 5 pm (OMA Q-codes guide p.8).
• Sessions must be open to scheduled and unscheduled patients, at regular times patients are told about (OMA Q-codes guide p.8).
• Not for patients seen after 5 pm because the clinic is behind schedule, and daytime hours shouldn't be moved to bill it (OMA Q-codes guide p.8).
• Comprehensive virtual services earn 30% of the virtual fee paid (AQ11).

Often billed with

• A007, A001, K005, K013, K030 and the other listed base codes, when the visit is in a scheduled after-hours session (OMA Q-codes guide p.8).

Common rejections

• VJ7: OHIP received the claim more than three months after the service date, so it was rejected as stale-dated.
• EPA: Q016A is limited to CCM physicians; EPA means OHIP doesn't show the physician approved to bill it under the billing number and group used on the service date.
• EH2: The health card version code on the claim doesn't match OHIP's record for the patient; get the current version code and resubmit.
• A3H: More services were billed on the line than OHIP allows for the code; check the number of services entered.
• VH8: The date of birth on the claim doesn't match OHIP's record for that health number; correct it and resubmit.

Related codes: Q012, Q017, Q018, A007, K013

Source: Schedule of Benefits (July 1, 2026), Appendix Q (information only), After Hours Fees, page AQ2; virtual care premiums, page AQ11

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