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W993 – Additional person(s) seen - Long-Term Care - Weekdays Daytime (07:00-17:00) with Sacrifice of Office Hours

OHIP General Preamble Code — GENERAL PREAMBLE · Schedule of Benefits

Billed by time of day

Special visit: Long-Term Care Institution, additional person seen. By when the visit starts. Schedule of Benefits GP73.. Toronto time.

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Special visit: Long-Term Care Institution, additional person seen by time period
Weekday daytimeMon–Fri 07:00–17:00
  • W991$20.55
  • W993(this code)with sacrifice of office hours$41.10
Weekday eveningMon–Fri 17:00–24:00
NightEvery day 00:00–07:00
Weekend or holidaySat, Sun & holidays 07:00–24:00
A premium for each additional person seen during the same non-elective special visit to a long-term care institution, for visits that commence on a weekday between 07:00 and 17:00 with sacrifice of office hours. Fee $41.10 (max. 10 (total of first and additional person seen) per time period). Schedule of Benefits Special Visit Premium Table IV, Long-Term Care Institution (). The time the special visit takes place must be documented in the medical record (). Bill with the appropriate A-prefix assessment from the General Listings.
The time at which the special visit takes place must be documented on the medical record.

Commentary: Special visit premiums are not eligible for payment for elective services rendered at a long-term care institution, including a nursing home or home for the aged, even when the long-term care institution is the "home" of the patient. Submit claims for routine elective visits in these locations as subsequent visits. For example, if the physician is called to a nursing home to see a patient for a non-elective problem at 8AM, and subsequently sees his/her routine patients on rounds, those additional patients do not qualify for the additional person premium.

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