W964 – Travel Premium - Weekdays Daytime with Sacrifice of Office Hours
OHIP Neurology Code — GENERAL PREAMBLE · Schedule of Benefits
This is a travel premium payable for a physician's travel to a Long-Term Care Institution to provide a non-elective service during weekdays daytime (07:00h - 17:00h) with sacrifice of office hours. As per the definition on , a special visit is initiated by a patient or their representative. This travel premium is payable once per trip, regardless of the number of patients seen, and cannot be claimed for travel within the same facility complex (). This premium must be billed with an appropriate A-prefix assessment code from the General Listings ().
When to Use
- Use W964 when you are called to a Long-Term Care (LTC) facility for an urgent, non-elective assessment during weekday business hours that forces you to cancel or delay scheduled office appointments.
- Apply this code when responding to a specific request from LTC staff to evaluate an acute change in a patient's condition that cannot wait for your next scheduled routine visit.
Common Pitfalls
- Billing W964 for routine, elective rounds or pre-planned follow-ups is a common audit trigger; these must be billed as subsequent visits without the premium.
- Attempting to claim W964 for multiple patients seen during the same trip will result in rejection, as the travel premium is strictly limited to once per trip regardless of volume.
- Failing to link the W964 to an A-prefix assessment code (e.g., A007) will cause the claim to be rejected for missing the required service component.
Billing Tips
- Always document the exact time of the call and the time of arrival at the facility to justify the 'non-elective' nature and the sacrifice of office hours in the event of an audit.
- If you see multiple patients during the same urgent trip, bill the W964 only once with the first patient's assessment, and bill subsequent patients using the appropriate A-prefix assessment codes without the travel premium.
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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