B963 – Travel Premium - Weekdays Daytime with Sacrifice of Office Hours
OHIP Paediatrics Code — GENERAL PREAMBLE · Schedule of Benefits
A travel premium for a special visit to a patient's home (other than a Long-Term Care Institution). A special visit is a visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service (). This premium, B963, is payable under the following conditions: - Location: Patient's home (not a Long-Term Care Institution). - Type: Non-elective visit. - Time: Weekdays, between 07:00h and 17:00h, with sacrifice of office hours. Payment Rules: - Only one travel premium is eligible for payment for each separate trip to a destination, regardless of the number of patients seen (). - An A-prefix assessment from the 'General Listings' must be claimed for the assessment rendered in conjunction with this premium (). Restrictions: - Not eligible for payment with A007 or A001 when rendered in a patient's home (). - Subject to all general Special Visit Premium rules on .
When to Use
- Use B963 when you must leave your office during scheduled hours to perform an urgent, non-elective home assessment for a patient who cannot travel.
- Use B963 for the first patient seen during a trip to a private residence when the visit is initiated by the patient for an acute issue requiring immediate attention.
Common Pitfalls
- Claiming B963 for a routine home visit or a scheduled follow-up, which does not meet the 'non-elective' requirement defined in GP65.
- Billing B963 alongside A001 or A007, which is explicitly prohibited because travel is considered included in the fee for those specific home assessment codes.
- Attempting to claim B963 for multiple patients at the same residence; only the first patient seen is eligible for the travel premium per trip.
Billing Tips
- Always pair B963 with an A-prefix assessment code (e.g., A003 or A005) to ensure the claim is processed correctly under the General Listings.
- Document the exact time of the visit in the medical record, as this is a mandatory requirement to validate the 'sacrifice of office hours' and the timing criteria for the premium.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table VI - Special Visits to Patient's Home)
The time at which the special visit takes place must be documented on the medical record.
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