W962 – Travel Premium - Long-Term Care Institution - Sat., Sun. and Holidays
OHIP Neurology Code — GENERAL PREAMBLE · Schedule of Benefits
A travel premium is payable for the travel required for a special visit to a patient in a Long-Term Care Institution. The service must be non-elective and initiated by or on behalf of the patient. This premium, W962, specifically applies when the visit commences on a Saturday, Sunday, or Holiday between 00:00h and 24:00h. Key payment rules from - include: - The travel premium is not payable for travel between locations within the same facility complex. - Claims for special visits must be submitted with an appropriate A-prefix assessment fee from the General Listings. - Special visit premiums are not payable for routine rounds or with services described by emergency department 'H' prefix fee codes. - The time of the special visit must be documented in the patient's medical record ().
When to Use
- Use when you are called to a long-term care facility on a weekend or holiday for an urgent, non-elective assessment that was not part of your pre-scheduled rounds.
- Use when responding to an urgent request from nursing staff to assess a patient for an acute change in condition, provided the visit is not routine.
Common Pitfalls
- Billing W962 for routine rounds or elective follow-ups, which are strictly prohibited under GP65 even if they occur on a weekend.
- Attempting to claim W962 when visiting multiple patients in the same facility; the premium applies to the travel for the special visit, not per patient.
- Failing to link the visit to an appropriate A-prefix assessment code, which will lead to automatic rejection of the travel premium.
Billing Tips
- Always pair W962 with the appropriate 'first person seen' premium (W994) to maximize the claim for the initial urgent assessment.
- Ensure the time of the visit is clearly recorded in the chart, as this is the primary audit point for verifying the 'non-elective' nature of the call.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table IV - Long-Term Care Institution)
The time at which the special visit takes place must be documented on the medical record.
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