A996 – First person seen
OHIP General Listings Code — GENERAL PREAMBLE · Schedule of Benefits
Special visit premium for the first person seen in a physician's office. A special visit is defined as a visit initiated by a patient or their representative for a non-elective service. This premium is specifically for visits that occur during the night (00:00h to 07:00h). It is payable in addition to an appropriate assessment fee from the General Listings (A prefix).
From :, special visit premiums are not eligible for payment in circumstances such as:
- Patients seen during routine hospital or long-term care institution rounds.
- Admission assessments for elective hospital admissions.
- Services in a location scheduled to be open (e.g., clinic during regular hours).
- Visits for which critical care team fees are payable.
- With services rendered by an Emergency Department Physician using H prefix codes.
- For patients who present to an office without an appointment while the physician is already there, or for patients seen immediately before, during, or after routine office hours.
When to Use
- Bill A996 for a patient presenting to your private office for an urgent, non-elective issue between midnight and 7:00 AM, in addition to a regular assessment code like A001.
- A996 is appropriate when you are called to see a patient in your office outside of regular business hours for a new, urgent medical concern, provided it's the first such patient visit in that night period.
- Use A996 for the first patient you see in your office during the night period (00:00h to 07:00h) for a non-elective service, ensuring you also bill an appropriate 'A' code for the assessment.
Common Pitfalls
- Do not bill A996 if the patient is seen during routine hospital rounds or for an elective hospital admission assessment, as these are explicitly excluded.
- Avoid billing A996 for services provided in a clinic that is open during regular hours, even if the patient's need is urgent; A996 is for non-scheduled, night-time office visits.
- Claims for A996 will be rejected if the service is rendered by an Emergency Department Physician using 'H' prefix codes or if critical care team fees are payable.
Billing Tips
- Always document the exact time of the special visit in the patient's medical record to support the A996 claim.
- Ensure you are billing an appropriate 'A' prefix assessment code from the General Listings alongside A996 to capture the full service.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table VIII - Physician Office)
The time at which the special visit takes place must be documented on the medical record.
Submit claims using the appropriate A-prefix assessment fee from the “General Listings” for an assessment rendered in conjunction with a special visit premium.
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