C106 – Additional person(s) seen
OHIP Surgical Procedures Code — OTHER PREMIUMS · Schedule of Benefits
A special visit premium payable to specialists in Diagnostic Radiology, Radiation Oncology, or Nuclear Medicine for each additional patient seen (after the first) during a night-time special visit (00:00-07:00) for the purpose of rendering non-elective diagnostic services in a hospital setting.
When to Use
- Use C106 when you have already billed the first patient under C108 and are required to interpret a second urgent, non-elective diagnostic study for a different patient during the same night-time hospital visit.
- Apply this code when multiple patients require urgent, non-elective diagnostic imaging or nuclear medicine procedures that necessitate your physical presence in the hospital between 00:00 and 07:00.
Common Pitfalls
- Billing C106 for interpretations performed remotely via PACS is a common audit trigger, as the premium strictly requires physical presence in the hospital.
- Attempting to bill C106 for multiple studies performed on the same patient during one visit will result in rejection; the premium is per additional patient, not per additional study.
- Failing to link the service to a specific, urgent clinical request that affects immediate patient management often leads to claim recovery during OHIP audits.
Billing Tips
- Always ensure the primary service (the diagnostic interpretation or procedure) is billed alongside C106 to establish the clinical necessity of the visit.
- If you travel to the hospital for these patients, ensure you append the C103 travel premium to the first patient's claim, as C106 is an add-on for subsequent patients seen during the same trip.
Effective: April 1, 2025
GP. General Preamble
OTHER PREMIUMS
Special Visit Premium
Age-Based Fee Premiums
The service must be non-elective.
The physician must be in the hospital for the purpose of interpreting results, performing a procedure, rendering a consultation, or concluding a procedure is not indicated.
The request for interpretation must relate to a patient's condition requiring urgent interpretation that affects the patient's management.
The visit must be initiated by the patient or an individual on behalf of the patient for a non-elective service.
Time period: Nights (00:00-07:00).
Fee: $77.10.
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