K960 – Travel Premium
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
This is a travel premium payable for a non-elective special visit to a patient in an Emergency Department, when the visit commences on weekdays between 07:00 and 17:00 (Monday to Friday). A special visit is defined as a visit initiated by a patient or an individual on their behalf for the purpose of rendering a non-elective service (). The travel premium is payable for travel from one location to another, but is not eligible for payment when a physician is required to travel between locations within the same hospital complex or on the same hospital campus. Only one travel premium is eligible for payment for each separate trip to a destination, regardless of the number of patients seen (). Key Restrictions: - This premium is not eligible for payment to Emergency Department Physicians (as defined on ). See . - Special visit premiums are not eligible for payment with emergency department 'H' prefix fee codes (). Claim Submission: - Claims for special visit premiums must be submitted with an appropriate A-prefix assessment fee from the General Listings ().
When to Use
- Use K960 when you are called in from your office or home to the Emergency Department for an urgent, non-elective assessment during weekday business hours (07:00-17:00).
- Apply this code when you are a consultant or specialist attending the ED for a specific patient request, provided you are not the designated Emergency Department physician on duty.
Common Pitfalls
- Billing K960 while working as the scheduled Emergency Department physician, which is strictly prohibited under GP67.
- Attempting to claim K960 alongside 'H' prefix codes, as these are mutually exclusive for the same patient encounter.
- Submitting K960 for travel between buildings on the same hospital campus, which fails the requirement for travel between separate locations.
Billing Tips
- Always pair K960 with an 'A-prefix' assessment code (e.g., A007) rather than an 'H-prefix' code to ensure the claim processes correctly.
- If you see multiple patients during the same trip, claim K960 only once for the first patient and use the appropriate 'H' codes for all subsequent patients seen during that same visit.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table I - Emergency Department)
The time at which the special visit takes place must be documented on the medical record.
Not eligible for payment to Emergency Department Physicians (see definition )
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