B997 – First person seen
OHIP Paediatrics Code — GENERAL PREAMBLE · Schedule of Benefits
A premium for the first person seen during a Palliative Care Home Visit at night (00:00-07:00). This premium is payable for a visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective or elective service in the patient's home. It is subject to the conditions and limitations for special visits as outlined in the Schedule of Benefits on pages to . This premium is only eligible for payment for the first patient seen, regardless of the number of patients seen during one visit to a home or to one or more living units in a multiple resident dwelling.
When to Use
- Use B997 when you are called to a patient's private home between 00:00 and 07:00 specifically for palliative care management.
- Use this for the first patient seen during a night-time home visit, even if you see subsequent patients in the same building or residence.
Common Pitfalls
- Billing B997 for patients residing in a long-term care facility or retirement home is a common audit trigger, as these are considered institutional settings rather than private homes.
- Attempting to claim B997 for a second patient seen in the same building during the same night-time trip will result in a rejection, as this premium is strictly limited to the first patient seen per visit.
Billing Tips
- Always pair B997 with the B966 travel premium to maximize the claim for the night-time home visit, ensuring both are submitted under the same service date and time.
- Ensure your clinical notes explicitly state the time of the visit and the palliative status of the patient to satisfy the documentation requirements for special visit premiums.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table VII - Palliative Care Home Visit)
The time at which the special visit takes place must be documented on the medical record.
A special visit means a visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service or, if rendered in the patient's home, a non-elective or elective service.
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