K994 – First Person Seen
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
K994 is a 'First Person Seen' special visit premium for services rendered in an Emergency Department. It is payable for a non-elective visit that commences during evening hours (17:00h - 24:00h) from Monday through Friday. A special visit is defined as a visit initiated by a patient or their representative for a non-elective service. This premium must be claimed with an appropriate assessment fee from the 'General Listings' (A-prefix codes), as per . Restrictions: - This premium is specifically not eligible for payment to physicians who are considered 'Emergency Department Physicians' as defined on . - It cannot be billed with 'H' prefix emergency department codes (). - The time of the visit must be documented in the patient's medical record ().
When to Use
- Use K994 when you are a non-ED physician (e.g., a consultant or family physician) called to the ED to provide a non-elective assessment between 17:00 and 24:00 on a weekday.
- Use K994 when performing an urgent consultation in the ED where you are not the physician of record for the ED department and the patient requires immediate, non-elective attention.
Common Pitfalls
- Billing K994 alongside H-prefix codes (e.g., H001, H002) will result in an automatic rejection; you must use an A-prefix assessment code (e.g., A007) instead.
- Physicians who are designated as 'Emergency Department Physicians' under GP67 are ineligible for K994, even if they are working a shift in the ED.
- Failure to document the exact start time of the visit in the chart is a frequent audit trigger that leads to full recovery of the premium.
Billing Tips
- Ensure your claim includes both the A-prefix assessment code and the K994 premium on the same claim submission to ensure the system recognizes the service as a special 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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