C992 – First person seen - Weekdays Evenings
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
A special visit premium payable for the first person seen during a special visit to a hospital in-patient. A special visit is a visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service. C992 is applicable under the following conditions: - Location: Hospital In-Patient (). - Time: Weekdays Evenings (17:00-24:00) (). Claims Submission: Claims for special visit premiums must be submitted using the appropriate A-prefix assessment fee from the 'General Listings' ().
When to Use
- Use C992 when you are called to the hospital by nursing staff or a colleague to assess an inpatient for an urgent, non-elective clinical issue between 17:00 and 24:00 on a weekday.
- Apply C992 when you have already left the hospital premises and are summoned back specifically to attend to a patient, provided the visit is not part of your regular scheduled rounds.
Common Pitfalls
- Billing C992 for routine follow-up visits or scheduled assessments performed while already on-site for other duties, which violates the 'special visit' requirement.
- Submitting C992 without an accompanying A-prefix assessment code (e.g., A007), which will result in an automatic rejection.
- Exceeding the maximum of 10 patients per time period when combining C992 and C993, as the Ministry strictly enforces this aggregate cap.
Billing Tips
- Always pair C992 with the C961 travel premium if you had to travel from your office or home to the hospital to see the patient.
- Ensure the exact time of the assessment is clearly recorded in the chart, as this is the primary audit point for verifying the 17:00-24:00 time window.
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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