< Billing codes

Billing code

C995A — Weekday evening in-patient special visit premium, additional patients

Evening call premium, extra patients

Add for each additional in-patient seen on a non-elective call, Monday to Friday, 17:00 to 24:00.

Watch for: Patients seen on rounds after the call don't qualify; bill with an A-prefix General Listings assessment.

Code

C995A

Description

Weekday evening in-patient special visit premium, additional patients

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 each additional hospital in-patient seen on a non-elective call, Monday to Friday 17:00 to 24:00.

What it covers

C995 is the 'additional person(s) seen' premium in Special Visit Premium Table III, Hospital In-Patient, for evenings 17:00 to 24:00, Monday to Friday (GP72).

It is billed for each in-patient seen at the destination after the first person (C994), when each additional service starts during the eligible times (GP66). A special visit is one initiated by the patient, or someone on their behalf, for a non-elective service (GP65).

Billing rules

• Each additional patient's service must start between 17:00 and 24:00 on a weekday (GP66).
• Maximum 10 patients per time period for C994 and C995 combined (GP72).
• Patients seen on rounds after the non-elective call don't qualify for the additional person premium (GP65, GP66).
• Not payable with the admission assessment of an elective admission, or for non-referred or transferred obstetrical patients (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).

Often billed with

• C994 first person seen on the same evening call (GP72).
• A933 on-call admission assessment for a non-elective admission, with E082 when the admitting physician is the MRP (A7, GP42).
• A003 general assessment as the A-prefix assessment for a patient seen on the call (A4, GP69).

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.

Related codes: C994, C962, C991, C997, C987, U995, A933

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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