K963 – Travel Premium
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
This is a travel premium for a special visit to an Emergency Department, as defined in Special Visit Premium Table I on . A special visit is a visit initiated by a patient or an individual on behalf of a patient for the purpose of rendering a non-elective service. This premium is applicable when a physician is required to travel to the hospital on a Saturday, Sunday, or Holiday between 07:00 and 24:00. Only one travel premium is payable per trip, regardless of the number of patients seen. This premium is not payable to physicians who are defined as Emergency Department Physicians (see ). The claim must be submitted with an appropriate A-prefix assessment code.
When to Use
- Use K963 when you are called into the Emergency Department on a weekend or holiday for an urgent, non-elective assessment and you are not the physician on-call for the ED.
- Apply this code when traveling to the hospital for an urgent consult that meets the criteria for a Special Visit Premium (Table I) during the 07:00-24:00 window on a Saturday, Sunday, or Holiday.
Common Pitfalls
- Billing K963 when you are already physically present in the hospital for other duties, as this premium specifically requires a separate trip initiated by a patient request.
- Attempting to bill K963 for multiple patients seen during the same trip; only one travel premium is payable per trip regardless of the volume of patients assessed.
- Incorrectly billing K963 if you are designated as the Emergency Department physician, as this premium is strictly prohibited for those on-duty in the ED.
Billing Tips
- Always pair K963 with an A-prefix assessment code (e.g., A007) and ensure the specific time of the visit is clearly documented in the chart to validate the 'special visit' status.
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.
This premium is part of Special Visit Premium Table I.
*Not eligible for payment to Emergency Department Physicians (see definition )*
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