W990 – First person seen
OHIP Neurology Code — GENERAL PREAMBLE · Schedule of Benefits
W990 is a special visit premium for the first patient seen during a non-elective special visit to a Long-Term Care Institution. This premium is applicable for services rendered on weekdays (Monday to Friday) during daytime hours (07:00-17:00). 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 in conjunction with an appropriate A-prefix assessment code. A travel premium (W960) and premiums for additional patients seen (W991) may also be applicable under specific conditions.
When to Use
- Use W990 when you are specifically called to a Long-Term Care facility for an urgent, non-elective assessment outside of your routine scheduled rounds.
- Apply this code when the visit is initiated by nursing staff or a family member for an acute change in patient status that requires immediate physician attention.
Common Pitfalls
- Claiming W990 for routine rounds or scheduled follow-ups is a frequent audit trigger, as it is strictly reserved for non-elective, unscheduled visits.
- Billing W990 alongside an elective admission assessment is prohibited and will result in automatic rejection by the Ministry.
- Failing to document the exact time of the visit in the patient chart will lead to claim recovery during a post-payment audit.
Billing Tips
- Always pair W990 with the appropriate A-prefix assessment code and include the travel premium W960 if you are traveling specifically to the facility for this patient.
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.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.