C994 – First person seen - Hospital In-Patient - Sat., Sun. and Holidays
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
This is a special visit premium payable for the first patient seen for a non-elective service rendered to a hospital in-patient. This premium applies when the service is commenced on Saturdays, Sundays, and Holidays (00:00-24:00). A special visit is defined as a visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service (see ). This premium must be claimed with an appropriate 'A' prefix assessment fee from the General Listings (see ). It is part of the 'Special Visit Premium Table III - Hospital In-Patient'.
When to Use
- Use C994 when you are called into the hospital specifically to assess a new, non-elective inpatient issue on a weekend or holiday, provided this is the first patient you see during that trip.
- Use this code for urgent, non-elective consultations or assessments where you have traveled to the hospital specifically for that patient, distinct from your routine daily rounds.
Common Pitfalls
- Billing C994 for patients seen during routine weekend rounds will result in a rejection or clawback, as special visit premiums are strictly prohibited for scheduled rounds.
- Claiming C994 in conjunction with an 'H' prefix emergency department code is invalid; these premiums only apply to 'A' prefix assessment codes from the General Listings.
- Failing to document the exact time the service commenced in the patient's chart is a common audit failure, as this is a mandatory requirement for all Table III premiums.
Billing Tips
- Always pair C994 with the appropriate 'A' prefix assessment code (e.g., A005, A007) and use C995 for any subsequent patients seen during the same trip.
- Ensure the visit is initiated by a request for a non-elective service, as self-initiated visits or routine follow-ups do not qualify for the premium.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table III - Hospital In-Patient)
For fee codes listed in Table III, the time at which the special visit takes place must be documented on the medical record.
When a special visit service occurs in a hospital where common medical records are maintained, the time when the visit takes place may be documented anywhere in the common medical record.
Submit claims using the appropriate A-prefix assessment fee from the “General Listings" for an assessment rendered in conjunction with a special visit premium.
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