C963 – Travel premium - Hospital In-Patient - Daytime with sacrifice of office hours
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
C963 is a travel premium payable for a special visit to a hospital in-patient. This premium applies to visits on Saturdays, Sundays, and Holidays, commencing between 07:00 and 24:00. As per , a special visit is initiated by a patient or their representative for a non-elective service. This travel premium is eligible for payment once per trip to a destination, regardless of the number of patients seen, and is not payable for travel within the same hospital complex (). Claims must be submitted with an appropriate A-prefix assessment fee from the General Listings ().
When to Use
- Use C963 when you are called into the hospital on a weekend or holiday between 07:00 and 24:00 to perform a non-elective assessment on an inpatient.
- Apply this code when you must leave your office during business hours on a weekend or holiday to attend to an urgent inpatient consultation or assessment.
Common Pitfalls
- Billing C963 for multiple patients seen during the same trip; the travel premium is payable only once per trip, regardless of the number of patients assessed.
- Attempting to claim C963 for travel between buildings within the same hospital complex, which is explicitly prohibited under GP66.
- Submitting C963 without an accompanying A-prefix assessment code (e.g., A007), which will result in an automatic rejection.
Billing Tips
- Ensure the exact time of the special visit is clearly documented in the patient's chart, as this is a mandatory audit requirement for all special visit premiums.
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.
The fee for this travel premium is $36.40.
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