K995 – Additional Person(s) seen
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
This is an 'Additional Person(s) seen' special visit premium for a non-elective service rendered to an additional patient (after the first) in an Emergency Department. This premium is applicable when the service is rendered during evening hours (17:00-24:00) Monday through Friday. It is explicitly not eligible for payment to physicians defined as 'Emergency Department Physicians' on .
When to Use
- Use K995 when you are a non-ED physician called to the ED to see a second or subsequent patient during the 17:00-24:00 window on weekdays.
- Apply this code when you have already billed a primary special visit premium (e.g., K992) for the first patient and are now attending to a second patient during the same visit.
Common Pitfalls
- Billing K995 as an ED physician defined under GP67 will result in automatic rejection, as this premium is reserved for non-ED staff.
- Claiming K995 without an accompanying A-prefix assessment code (e.g., A007) from the General Listings will trigger a rejection for missing the base service.
- Submitting K995 alongside H-prefix emergency codes is prohibited; you must use the corresponding A-prefix assessment codes for the service to be valid.
Billing Tips
- Ensure the exact start time of the service for each additional patient is documented in the chart to justify the premium during the 17:00-24:00 window.
- Always link the K995 to the specific A-prefix assessment code performed for that additional patient to ensure the claim passes the validation logic.
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.