K964 – Travel Premium
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
K964 is a travel premium payable for a trip made to render a non-elective service to a patient in an Emergency Department. This premium specifically applies to visits that commence during night hours, defined as the period from 00:00 to 07:00. As per the general rules for special visits outlined on page , this premium is only payable when rendered with eligible assessments or procedures and cannot be claimed for routine or scheduled activities. It is also subject to several restrictions, including: - It is not payable to Emergency Department Physicians (see definition on ). - It is not payable with any H prefix emergency department fee codes. - Only one travel premium is payable per trip to the destination, regardless of the number of patients seen ().
When to Use
- Use K964 when you are called in from outside the hospital to the Emergency Department between 00:00 and 07:00 to perform a non-elective consultation or procedure.
- Use this code when you are already at the hospital for a separate, unrelated purpose but are specifically summoned to the Emergency Department to attend to a patient, provided the visit meets the non-elective criteria.
Common Pitfalls
- Billing K964 alongside H-prefix emergency department codes will result in an automatic rejection, as these are mutually exclusive.
- Attempting to claim K964 for multiple patients seen during the same trip is a common audit trigger; only one travel premium is payable per trip regardless of patient volume.
- Emergency Department Physicians are strictly prohibited from claiming K964, as their presence in the department is considered part of their routine duties.
Billing Tips
- Always pair K964 with the appropriate 'First Person Seen' premium (e.g., K990) to maximize the value of the non-elective night call.
- Ensure the exact time of the special visit is clearly documented in the medical record, as this is the primary data point used to verify the 00:00-07:00 eligibility window.
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 )*
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.