K961 – Travel Premium
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
A special visit is a visit initiated by a patient or on their behalf for a non-elective service, as defined on . K961 is the travel premium for such a visit to an Emergency Department. It is payable for travel from one location to another but is not eligible for travel within the same hospital complex (). This specific premium applies to visits on weekdays during daytime hours (07:00 - 17:00) that require a 'Sacrifice of Office Hours'. 'Sacrifice of office hours' is defined on as an unscheduled, non-elective visit that causes the physician to delay or cancel a previously booked office appointment. Per , claims for the assessment rendered during the special visit must be submitted using an 'A' prefix fee code. This premium is not payable to Emergency Department Physicians (see definition on ).
When to Use
- Use K961 when you are called from your private office to the Emergency Department for a non-elective, urgent assessment that forces you to cancel or delay scheduled office patients.
- Apply this code when traveling from your community office to a hospital Emergency Department to provide a service that cannot wait for your next scheduled hospital round.
Common Pitfalls
- Billing K961 when you are already physically present in the hospital complex; travel premiums are strictly for travel between distinct locations, not within the same building.
- Submitting K961 for an Emergency Department Physician; this code is explicitly restricted for those defined as ED physicians under GP67.
- Attempting to claim K961 alongside an H-prefix code; all assessments associated with a special visit premium must use an A-prefix code.
Billing Tips
- Ensure your chart note explicitly states the time of the visit and the fact that an office appointment was sacrificed, as this is the primary audit trigger for this premium.
- If you see multiple patients during a single trip to the ED, claim the A-prefix assessment code for each patient but only attach the K961 travel premium to the first patient seen.
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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