W997 – Additional person(s) seen
OHIP Neurology Code — GENERAL PREAMBLE · Schedule of Benefits
W997 is a special visit premium payable for each additional patient seen after the first during a single non-elective visit to a Long-Term Care Institution. The service must commence during weekdays daytime hours (07:00h to 17:00h) and require sacrifice of office hours. As per the general rules for special visits on pages -, a special visit must be initiated by a patient or their representative for a non-elective service. This premium is claimed in addition to an appropriate A-prefix assessment fee and cannot be claimed for routine rounds. The time of the visit must be documented in the medical record. There is no maximum limit on the number of 'additional person seen' premiums that can be claimed during this time period.
When to Use
- Use W997 when you are called to a Long-Term Care facility for a non-elective assessment and are requested to see additional patients during that same urgent trip.
- Apply W997 for each subsequent patient seen after the first patient (who triggers the primary W996 premium) during a single non-elective visit to a Long-Term Care institution.
Common Pitfalls
- Claiming W997 for routine rounds or elective follow-ups performed during the same trip as a non-elective visit will result in audit recovery.
- Submitting W997 without an accompanying A-prefix assessment fee for each additional patient seen will cause the claim to be rejected.
- Failing to document the specific time of the visit in each patient's chart is a common cause for rejection during OHIP audits.
Billing Tips
- Ensure the primary patient is billed with the appropriate W996 premium, then use W997 for every subsequent patient seen during that same non-elective 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.
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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