C995 – Additional person(s) seen
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
A special visit premium for an additional person seen for a non-elective service rendered to a hospital in-patient. Per , an additional person premium is only eligible for payment for services rendered at the destination to additional patients after a 'first person seen' service has been provided. This premium applies when the service for the additional patient is commenced during Saturdays, Sundays, and Holidays between 00:00 and 24:00. As per , the visit must be initiated by a patient or their representative for a non-elective service. This premium is subject to a combined maximum with the 'first person seen' premium (C994) for the same time period.
When to Use
- Use C995 for the second and subsequent patients seen during a non-elective hospital visit on weekends or holidays, provided the first patient was billed with C994.
- Apply this code when you are already at the hospital for a non-elective service and are requested to see another patient in the same facility during the same weekend or holiday time block.
Common Pitfalls
- Billing C995 without a corresponding C994 for the first patient seen in the same visit block will result in an automatic rejection.
- Attempting to bill C995 for patients seen in the Emergency Department is prohibited, as this code is restricted to hospital in-patient services only.
- Claiming C995 for elective services or routine rounds will lead to audit recovery, as the service must be non-elective and initiated by the patient or representative.
Billing Tips
- Ensure the start time for each additional patient is clearly documented, as the service must commence within the eligible Saturday, Sunday, or Holiday window to qualify for the premium.
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 consist of a 'travel premium' and a 'patient seen' premium (either a 'first person seen premium' or an 'additional person seen premium'). C995 is an additional person seen premium.
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