B996 – First person seen - Special visit to patient's home - Nights
OHIP Paediatrics Code — GENERAL PREAMBLE · Schedule of Benefits
A special visit premium payable for the first patient seen during a non-elective special visit to a patient's home (excluding Long-Term Care institutions) between 00:00 and 07:00, Monday through Friday.
When to Use
- Use B996 for an urgent, non-elective house call requested by a patient or caregiver between 00:00 and 07:00 on a weekday.
- Use B996 when responding to an acute clinical deterioration in a private residence that necessitates an immediate, in-person assessment.
Common Pitfalls
- Billing B996 for elective home visits, which must be billed under B990 regardless of the time of day.
- Attempting to bill B996 for patients residing in Long-Term Care facilities, which requires the use of W996 instead.
- Billing B996 for multiple patients in the same building; only the first patient seen in a multi-unit dwelling is eligible for the premium.
Billing Tips
- Always pair B996 with the appropriate assessment code (e.g., A4) and the B964 travel premium to ensure full compensation for the night-time visit.
- Ensure the exact time of the visit is clearly documented in the chart to validate the non-elective nature and the specific time-based eligibility of the premium.
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 visit must be initiated by the patient or someone on their behalf for a non-elective service.
A 'multiple resident dwelling' (e.g., apartment block, retirement home, group home) is considered a single location. Only the first person seen in the entire building during that visit is eligible for B996.
If multiple patients are seen in the same home, no 'additional person' premium is available for home visits (unlike Hospital or LTC settings).
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