B993 – First person seen - Special visit premium
OHIP Paediatrics Code — GENERAL PREAMBLE · Schedule of Benefits
A special visit premium payable for the first patient seen during a non-elective visit to a patient's home (other than a Long-Term Care Institution) during weekday daytime hours (07:00-17:00) when the physician is required to sacrifice office hours.
When to Use
- Use B993 when a non-elective, urgent home visit requires you to cancel or delay existing office appointments to travel to the patient's residence.
- Use B993 for the first patient seen in a private home during weekday daytime hours (07:00-17:00) when the visit is initiated by the patient or their representative.
Common Pitfalls
- Billing B993 for visits to patients in Long-Term Care or retirement homes, which are explicitly excluded from the 'home' definition for this premium.
- Claiming B993 for elective home visits, which should instead be billed under B990, or failing to document the sacrifice of office hours which is a mandatory audit requirement.
- Attempting to bill an 'additional person' premium for subsequent patients in the same dwelling; only the first patient qualifies for a premium in a home setting.
Billing Tips
- Always pair B993 with the travel premium B963 when traveling from your office to the patient's home to maximize the claim for the sacrifice of office hours.
- Ensure the time of the visit is clearly documented in the patient's chart, as this is the primary data point used to verify the 'sacrifice of office hours' during OHIP audits.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Special Visit Premium
Premium
A multiple resident dwelling (e.g., apartment, retirement home, hostel) is considered a single destination; only one 'first person seen' premium is payable regardless of the number of units visited.
Special visit premiums are not eligible for elective services in long-term care institutions even if it is the patient's home.
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