W994 – First person seen - Sat., Sun. and Holidays
OHIP Neurology Code — GENERAL PREAMBLE · Schedule of Benefits
This is a premium payable for the first patient seen during a non-elective special visit to a patient in a Long-Term Care Institution. It applies when the visit commences on a Saturday, Sunday, or Holiday between 00:00 and 24:00. A special visit is a visit initiated by a patient or an individual on their behalf for a non-elective service as defined on . This premium must be billed with an appropriate 'A' prefix assessment code from the General Listings. The time of the special visit must be documented in the patient's medical record as per .
When to Use
- Use W994 when you are called to a Long-Term Care (LTC) facility on a weekend or holiday for an urgent, non-elective assessment that was not pre-scheduled.
- Use this code for the first patient seen during an urgent visit to an LTC facility, provided the service is initiated by the patient or staff due to an acute change in condition.
Common Pitfalls
- Billing W994 for routine, elective LTC visits; these must be billed as standard subsequent visit codes (e.g., W010) without a special visit premium.
- Failing to document the exact time of the visit in the patient's chart, which is a mandatory requirement under GP69 for all special visit premiums.
- Attempting to bill W994 in conjunction with Emergency Department premiums (Table I), as these are mutually exclusive per GP65.
Billing Tips
- Always pair W994 with an appropriate 'A' prefix assessment code (e.g., A007) to ensure the premium is triggered correctly in the OHIP system.
- Ensure you do not exceed the maximum of 10 special visit premiums per period, as W994 shares this limit with other Table IV 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.
Special visit premiums are not eligible for payment for elective services rendered at a long-term care institution, including a nursing <term>home</term> or <term>home</term> for the aged, even when the long-term care institution is the "<term>home</term>" of the patient. Submit claims for routine elective visits in these locations as subsequent visits.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.