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Billing code

C994A — Weekday evening in-patient special visit premium, first patient

Evening call premium, first patient

Add for the first in-patient seen on a non-elective call that starts Monday to Friday, 17:00 to 24:00.

Watch for: Bill it with an A-prefix General Listings assessment, not the C-prefix in-patient visit, and record the visit time.

Code

C994A

Description

Weekday evening in-patient special visit premium, first patient

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Special visit premium for the first hospital in-patient seen on a non-elective call that starts Monday to Friday, 17:00 to 24:00.

What it covers

C994 is the 'first person seen' premium in Special Visit Premium Table III, Hospital In-Patient, for evenings 17:00 to 24:00, Monday to Friday (GP72). It pays for the first patient seen at the destination when the service starts in that period (GP66).

A special visit is one initiated by the patient, or someone on their behalf, for a non-elective service (GP65). Later patients seen on the same evening call are billed with C995 (GP66, GP72).

Billing rules

• The service must start between 17:00 and 24:00 on a weekday; the start time sets the period (GP66).
• Maximum 10 patients per time period for C994 and C995 combined (GP72).
• A travel premium isn't required in the evening. C962 is added only when the physician travels to the hospital, not between buildings on the same campus (GP66, GP72).
• Not payable for patients seen on rounds, with the admission assessment of an elective admission, for non-referred or transferred obstetrical patients, or for a visit that pays critical care team fees (GP65).
• Bill the A-prefix assessment or consultation from the General Listings with the premium, not the C-prefix in-patient listing (GP12, GP69).
• The time of the visit must be in the medical record; in a hospital it can be anywhere in the common medical record (GP69).
• An emergency department physician called to a hospital ward on a non-elective basis bills the A-prefix General Listings, and the Table III C-prefix premium may be eligible (GP68).

Often billed with

• C995 for each additional in-patient seen on the same evening call (GP72).
• C962 travel premium, maximum 2 per time period (GP72).
• A933 on-call admission assessment with E082 (+30%) when the physician admits the patient non-electively and is the MRP (A7, GP42).

Common rejections

• ADF: OHIP's description is 'required related procedure missing, invalid or paid at zero'. A special visit premium is only paid with an eligible service from Consultations and Visits (claimed with the A-prefix General Listings code) or Diagnostic and Therapeutic Procedures (GP65, GP69), so check that the service is on the same claim and payable.
• V66: OHIP's description is 'missing admission date'. Add the admission date of the patient's current hospital stay to the claim and resubmit.

Related codes: C995, C962, C990, C996, C986, U994, A933, E082

Source: Schedule of Benefits (July 1, 2026), General Preamble, Special Visit Premiums, pages GP65 to GP69 and Table III on GP72

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