W991 – Additional person(s) seen
OHIP Neurology Code — GENERAL PREAMBLE · Schedule of Benefits
The W991 premium is payable for an additional patient seen during a non-elective special visit to a Long-Term Care Institution. A special visit is a visit initiated by a patient or their representative for the purpose of rendering a non-elective service (). This specific premium is for services that commence on weekdays (Monday to Friday, excluding holidays) during daytime hours (07:00-17:00). Per page , it must be claimed in addition to an appropriate A-prefix assessment fee from the 'General Listings'. It is not payable for routine rounds or elective services.
When to Use
- Use W991 for the second and subsequent patients seen during the same non-elective special visit to an LTC facility where W990 was claimed for the first patient.
- Apply this code when you are called to an LTC facility for an urgent, non-elective assessment of multiple residents during weekday daytime hours (07:00-17:00).
Common Pitfalls
- Claiming W991 for routine, pre-scheduled, or elective LTC rounds, which must be billed as subsequent visit codes (e.g., W002) without a special visit premium.
- Submitting W991 without an accompanying A-prefix assessment code (e.g., A007) for each individual patient, leading to automatic rejection.
- Failing to document the specific time of the visit in each patient's chart, which is a mandatory requirement under GP69 for all special visit premiums.
Billing Tips
- Always pair W991 with the corresponding A-prefix assessment code for the specific patient being seen to ensure the claim is processed as a valid special visit encounter.
- Ensure the visit was initiated by the facility or patient representative for a non-elective issue, as elective care does not qualify for the W-series LTC premiums.
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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