W963 – Travel Premium - Long-Term Care Institution - Nights
OHIP Neurology Code — GENERAL PREAMBLE · Schedule of Benefits
W963 is a travel premium for a special visit to render a non-elective service at a Long-Term Care Institution. A special visit is initiated by a patient or an individual on their behalf. This premium applies when the visit occurs during Nights (00:00h-07:00h). It is payable for the travel from one location to the destination. Only one travel premium is payable per trip, regardless of the number of patients seen. It is not payable for travel between locations within the same facility complex. Claims for the associated assessment must use the appropriate 'A' prefix fee code from the General Listings.
When to Use
- Use W963 when you are called out of your home or office between 00:00h and 07:00h to attend to a patient in a Long-Term Care facility for an urgent, non-elective clinical issue.
- Apply this code when the visit is specifically initiated by the facility staff or the patient due to an acute change in status that cannot wait until regular morning rounds.
Common Pitfalls
- Billing W963 for routine, elective visits or pre-scheduled rounds at a nursing home will result in automatic rejection or audit recovery.
- Submitting W963 in conjunction with a subsequent visit code (e.g., W002) is incorrect; you must use an 'A' prefix assessment code (e.g., A007) for the clinical service provided.
- Attempting to claim W963 for multiple patients seen during the same trip is prohibited; only one travel premium is payable per trip regardless of the number of patients assessed.
Billing Tips
- Ensure the exact time of the visit is clearly recorded in the patient's chart to substantiate the 'Night' designation (00:00h-07:00h) during a potential audit.
- If you see multiple patients during a single emergency trip, bill the 'A' prefix assessment for each patient, but only attach the W963 travel premium to the first patient's claim.
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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