< Billing codes

Billing code

K994A — Evenings (17:00 - 24:00) Monday Thorugh Friday

ED visit first patient, evening

Bill K994 for the first patient on a weekday evening (17:00–24:00) emergency department special visit by a physician not on ED duty.

Watch for: Submit it on the same claim as the A-prefix assessment, not H-prefix codes; not payable to ED physicians.

Code

K994A

Description

Evenings (17:00 - 24:00) Monday Thorugh Friday

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

ED special visit premium for the first patient seen, weekday evening 17:00–24:00. Not payable to Emergency Department Physicians.

What it covers

K994 is the first-person-seen premium when a physician who is not on duty in the emergency department makes a special visit to the ED, on a weekday evening (17:00–24:00, Monday to Friday) (GP70, Table I). A special visit is one initiated by or for the patient for a non-elective service (GP65).

The travel premium for the same period is K962, and further patients seen on that visit use K995 (GP70).

Billing rules

• Not payable to Emergency Department Physicians (scheduled ED staff or scheduled ED on-call), who use Table V (H-prefix premiums) instead (GP67, GP70).
• Bill with the appropriate A-prefix assessment from the General Listings; not payable with ED H-prefix codes (GP65, GP69).
• Maximum: 10 first and additional persons seen combined per time period (GP70). Patients beyond the limit on that visit are billed with H-prefix codes (GP68).
• Not payable for patients seen on rounds, with critical care team fees, for elective admissions, or for walk-ins or patients seen just before, during or after regular office hours (GP65).
• Record the time of the special visit in the medical record (GP69).
• Procedures started in the evening on the same visit can also take E409 (+50%) (SP2, GP104).

Often billed with

• K962 travel premium for the same time period (GP70).
• An A-prefix assessment from the General Listings (GP69).

Common rejections

• AD9: 'Premium not allowed alone': the premium was billed without an eligible service, such as the A-prefix assessment, on the claim (GP65, GP69).

Related codes: K962, K995, K992, K998, K996, E409

Source: Schedule of Benefits (July 1, 2026), General Preamble, Special Visit Premiums (Table I – Emergency Department), page GP70; rules GP65–GP69.

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