B994 – First person seen - Special visit to patient's home
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) on Saturdays, Sundays, or Holidays (00:00-24:00).
When to Use
- Use B994 when performing an urgent, non-elective home visit on a Saturday, Sunday, or Holiday for the first patient seen.
- Use B994 in conjunction with an appropriate assessment code like A003 or A004, as A001 and A007 are strictly prohibited for home visits with special visit premiums.
Common Pitfalls
- Billing B994 with A001 or A007 will result in an automatic rejection because travel is already bundled into those assessment codes.
- Attempting to bill B994 for elective home visits is a common audit trigger; elective visits must use B990 regardless of the day of the week.
- Failing to bill the B962 travel premium alongside B994 results in lost revenue, as B994 covers the premium for the visit but not the travel component itself.
Billing Tips
- Always pair B994 with B962 to ensure you are compensated for both the first-person premium and the travel to the patient's home.
- Ensure the assessment code used with B994 is not restricted; use A003, A004, or other eligible assessment codes instead of the prohibited A001/A007.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Special Visit Premium
Premium
The time at which the special visit takes place must be documented in the medical record.
The physician must travel from one location to the patient's home (the destination).
The physician must be available to provide follow-up care or arrange coverage.
A multiple resident dwelling is defined as a single location sharing a common external entrance (e.g., apartment, retirement home, hostel, group home).
Travelling to visit a patient outside the physician's usual geographical area of practice is an uninsured service.
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