C961 – Travel premium - Hospital In-Patient - Weekdays Evenings
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
This is a Travel Premium for a special visit to a Hospital In-Patient as defined in SPECIAL VISIT PREMIUM TABLE III on page . It is payable for a visit initiated for a non-elective service that occurs on a weekday (Monday to Friday) between 17:00 and 24:00. This premium covers the travel to the hospital and is limited to one per trip. It must be claimed with an appropriate assessment code from the General Listings ('A' prefix codes).
When to Use
- Use C961 when you are called back to the hospital for an urgent, non-elective assessment of an inpatient between 17:00 and 24:00 on a weekday.
- Apply this code when you have already left the hospital premises and are required to return specifically to attend to a patient, distinct from your regular scheduled rounds.
Common Pitfalls
- Billing C961 for a patient seen during a routine or scheduled hospital visit, which is ineligible as the visit must be initiated by a specific request for a non-elective service.
- Claiming C961 when you are already physically present in the hospital for other duties, as the premium is intended to compensate for the travel time and effort of a return trip.
- Exceeding the maximum of two claims per time period, which will trigger an automatic rejection from OHIP.
Billing Tips
- Always pair C961 with the appropriate 'A' prefix assessment code (e.g., A005 or A007) and ensure the exact start time of the visit is clearly documented in the chart to justify the evening time window.
- If you see multiple patients during the same trip, claim the travel premium only once for the first patient and use the 'First Person Seen' premium (e.g., K961) for subsequent patients seen during that same trip.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table III - Hospital In-Patient)
The time at which the special visit takes place must be documented on the medical record.
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