< Billing codes

Billing code

C996A — Night in-patient special visit premium, first patient

Night call premium, first patient

Add for the first in-patient seen on a non-elective call that starts between 00:00 and 07:00, any day.

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

Code

C996A

Description

Night 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 at night, 00:00 to 07:00. No maximum per period.

What it covers

C996 is the 'first person seen' premium in Special Visit Premium Table III, Hospital In-Patient, for nights 00:00 to 07:00 (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). Further in-patients seen on the same night call are billed with C997 (GP72).

Billing rules

• The service must start between 00:00 and 07:00, any day of the week (GP66, GP72).
• No maximum number of patients per time period (GP72).
• A travel premium isn't required at night. C964 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).

Often billed with

• C997 for each additional in-patient seen on the same night call (GP72).
• C964 travel premium, no maximum 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

• V18: OHIP's description is 'invalid admission/first visit date'. Check that the admission date on the claim is the date of this hospital admission.

Related codes: C997, C964, C994, C986, U996, A933, E082

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

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing