C996 – First person seen - Hospital In-Patient - Nights
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
A special visit premium for the first patient seen for a non-elective service rendered to a hospital in-patient. A special visit is defined in as a visit initiated by a patient or an individual on their behalf for the purpose of rendering a non-elective service. This premium applies when the service commences during night hours, defined as the period from Monday through Friday 00:00h to 07:00h. It is payable in addition to the fee for the primary assessment (which must be claimed using an A-prefix code as per ) and any applicable travel premium, such as C964.
When to Use
- Use C996 when you are called in to the hospital between 00:00 and 07:00 on a weekday to perform an urgent, non-elective assessment on an admitted patient.
- Apply this code when you are already in the hospital for a previous patient but are called to see a new, separate patient for an urgent issue during the specified night hours.
Common Pitfalls
- Billing C996 for a patient seen in the Emergency Department; this code is strictly for hospital in-patients and is rejected if paired with H-prefix codes.
- Failing to record the exact start time of the service in the chart, which is a mandatory audit requirement for all special visit premiums.
- Attempting to claim C996 for elective procedures or routine rounds, as the service must be initiated by a request for a non-elective, urgent clinical need.
Billing Tips
- Always pair C996 with the appropriate A-prefix assessment code (e.g., A007) to ensure the claim is processed correctly as a special visit.
- If you see multiple patients during the same night call-out, claim C996 for the first patient and use the appropriate subsequent patient premium (C997) for the others.
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.
The fee for this premium is listed as $100.00 in the Special Visit Premium Table III on page of the Schedule of Benefits.
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