H960 – Travel Premium
OHIP Obstetrics Code — GENERAL PREAMBLE · Schedule of Benefits
H960 is a travel premium payable for a special visit to an Emergency Department rendered by an Emergency Department Physician. This premium applies to non-elective services provided during weekdays between 07:00 and 17:00. Definition of Emergency Department Physician (): An Emergency Department Physician is a physician who: a. on a day when scheduled to work in an ED, is requested by the ED to attend at a time when not otherwise scheduled, and is not at the hospital when the request is made. b. is on-call for an ED and is not at the hospital when the request for attendance is made. Key Conditions (, , ): - The visit must be initiated by a patient or on their behalf for a non-elective service. - The physician must travel from one location to the hospital ED. The premium is not payable if the physician is already at the hospital complex. - Must be rendered with an appropriate A-prefix assessment fee. - Not payable with 'H' prefix emergency department fee codes.
When to Use
- Use H960 when you are on-call for the ED, are off-site, and are called in to attend a non-elective patient between 07:00 and 17:00 on a weekday.
- Use H960 when you are scheduled for an ED shift, but are called in to attend a patient at the ED during a time you were not otherwise scheduled to be on-site.
Common Pitfalls
- Billing H960 when you are already on the hospital premises for other duties, which violates the requirement that you must travel from an off-site location.
- Attempting to claim H960 alongside H-prefix emergency department codes, which is explicitly prohibited under GP67.
- Failing to document the exact time the request for attendance was made, which is a mandatory requirement for audit compliance under GP69.
Billing Tips
- Always pair H960 with an appropriate A-prefix assessment code from the General Listings, as the premium cannot be billed as a standalone service.
- Ensure your claim includes the specific clinical reason for the urgent attendance to satisfy the documentation requirements outlined in GP69.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table V - Emergency Department by Emergency Department Physician)
The time of the request to attend in the emergency department must be documented on the medical record.
The specific situation requiring the physician's attendance must be documented on the 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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