W995 – Additional person(s) seen - Sat., Sun. and Holidays
OHIP Neurology Code — GENERAL PREAMBLE · Schedule of Benefits
This premium applies to each additional patient seen after the first during a non-elective special visit to a Long-Term Care Institution. The visit must commence on a Saturday, Sunday, or Holiday between 00:00 and 24:00. It is payable in addition to an appropriate assessment fee (claimed with an 'A' prefix) and any applicable travel premium. This premium is subject to a combined maximum with the 'first person seen' premium (W994) for the same time period.
When to Use
- Use W995 for the second and subsequent patients seen during a non-elective, urgent visit to a Long-Term Care (LTC) facility on a weekend or holiday.
- Apply this code when you have already billed W994 for the first patient seen during the same non-elective trip to the LTC facility.
Common Pitfalls
- Billing W995 for routine, elective rounds performed during the same trip as an urgent visit; elective visits must be billed as subsequent visits only.
- Claiming W995 when the visit was pre-scheduled or elective, as special visit premiums are strictly reserved for non-elective, urgent clinical needs.
- Failing to document the exact start time of the visit, which is a mandatory requirement for all special visit premium claims.
Billing Tips
- Always pair W995 with an A-prefix assessment code (e.g., A007) and ensure the travel premium (W962) is included on the claim for the first patient to maximize reimbursement for the trip.
- Ensure the total number of patients claimed with W995 does not exceed the total number of patients seen during the non-elective window, as audit triggers often flag high volumes of premium claims per visit.
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.
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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