C991 – Additional person(s) seen
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
C991 is a special visit premium for an 'Additional person(s) seen' as part of a non-elective visit to a hospital in-patient. It is applicable during 'Weekdays Daytime' (Monday to Friday, 07:00-17:00), excluding visits with sacrifice of office hours. This premium is intended to be claimed for the second and subsequent patients seen during a single special visit, following the 'first person seen' for whom a different premium (C990) would be claimed. As per , a special visit must be non-elective and initiated by or on behalf of the patient. The time of the visit must be documented in the medical record (). Claims for this premium must be submitted with an appropriate A-prefix assessment fee from the 'General Listings' ().
When to Use
- Use C991 for the second and subsequent patients when you are called into the hospital for a non-elective, urgent issue and see multiple patients during that same trip.
- Apply C991 when you have already claimed the 'first person seen' premium (C990) for the initial patient who necessitated the special visit.
Common Pitfalls
- Claiming C991 for routine hospital rounds performed after an urgent call is a frequent audit trigger; the premium only applies to the non-elective patients seen during that specific trip.
- Submitting C991 without an associated A-prefix assessment code will result in an automatic rejection, as the premium must be attached to a valid service fee.
- Attempting to claim C991 for patients seen during routine or ordinary office hours, even if the office is located within a hospital setting, is strictly prohibited.
Billing Tips
- Ensure the exact time of the visit is documented in each patient's chart, as this is a mandatory requirement for all special visit premiums under GP69.
- Always sequence C990 for the first patient and C991 for all subsequent patients to ensure the claim logic correctly identifies the primary and additional 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.
Special visit premiums are in respect of either or both: a "travel premium" and a "patient seen" premium (i.e. "first person seen premium" or "an additional person seen premium").
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