C986 – First person seen - Daytime with Sacrifice of Office Hours
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
C986 is a premium payable for the first hospital in-patient seen during a non-elective special visit that commences during daytime hours (07:00-17:00) requiring sacrifice of office hours. This premium is claimed in addition to an appropriate assessment or procedure fee, typically an 'A' prefix code from the General Listings as described on page . It is not payable for routine rounds or with 'H' prefix emergency department codes as noted on . The time of the visit must be documented in the patient's medical record. A maximum of 20 first and additional person seen premiums (C986, C987) are payable per physician during this time period.
When to Use
- Use C986 when you are called away from your private office during 07:00-17:00 to perform a non-elective assessment on an existing hospital in-patient.
- Use C986 for the first patient seen when a hospital in-patient requires an urgent, non-elective procedure or assessment that forces you to cancel or delay scheduled office appointments.
Common Pitfalls
- Claiming C986 for routine hospital rounds is a common audit trigger; it is strictly reserved for non-elective, unscheduled visits that interrupt office hours.
- Billing C986 alongside an 'H' prefix emergency department code will result in an automatic rejection, as Table III premiums are restricted from Table I services.
- Failing to document the exact start time of the visit in the patient record is a frequent cause for recovery during OHIP audits.
Billing Tips
- Always pair C986 with an appropriate 'A' prefix assessment code from the General Listings, as the premium cannot be claimed as a standalone service.
- Ensure your billing software clearly distinguishes between C986 (first patient) and C987 (subsequent patients) to stay within the 20-claim daily limit for this time block.
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.
Special visit premiums are only eligible for payment when rendered with certain services listed under 'Consultations and Visits' and 'Diagnostic and Therapeutic Procedures' sections of this Schedule.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.