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A994
A994 – First person seen
OHIP General Listings Code — GENERAL PREAMBLE · Schedule of Benefits
A special visit premium payable for the first person seen during a non-elective special visit to a physician's office commenced during evening hours (17:00-24:00) Monday through Friday.
When to Use
- Bill A994 when a patient presents to your office for an unscheduled, non-elective visit between 17:00 and 24:00 on a weekday, and this is the first patient you are seeing during that specific evening period.
- Use A994 for the first patient seen during an unscheduled evening visit (17:00-24:00 weekdays) that requires immediate attention, distinguishing it from routine scheduled appointments.
- A994 is appropriate for the initial patient encounter during an unscheduled evening visit that cannot wait until the next business day, provided it falls within the 17:00-24:00 timeframe.
Common Pitfalls
- Billing A994 for patients seen outside the 17:00-24:00 Monday-Friday window will result in rejection.
- Do not bill A994 if the patient has a scheduled appointment, as this premium is only for non-elective, unscheduled visits.
- Submitting A994 without a corresponding A-prefix assessment code will lead to claim rejection.
Billing Tips
- Ensure the medical record clearly documents the exact start time of the visit to support the evening premium (A994).
- A994 can be billed alongside A962 (Travel Premium - Physician Office - Evenings) if you traveled to your office for the unscheduled evening visit.
Provider Fee$61.70
Effective: April 1, 2026
Category
GP. General Preamble
Subcategory
GENERAL PREAMBLE
Service Type
Special Visit Premium
Code Classes
Premium
The time at which the special visit takes place must be documented on the medical record.
The visit must be non-elective.
Special visit premiums are not eligible for virtual care (Appendix J)
Sacrifice of office hours is not a requirement for this evening premium (unlike the daytime A990)
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