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Billing code

K996A — Nights (00:00 - 07:00)

ED visit first patient, night

Bill K996 for the first patient on a night (00:00–07:00) 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

K996A

Description

Nights (00:00 - 07:00)

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, night 00:00–07:00. Not payable to Emergency Department Physicians.

What it covers

K996 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, at night (00:00–07:00) (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 K964, and further patients seen on that visit use K997 (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).
• No maximum number of patients per time period (GP70).
• 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 at night on the same visit can also take E410 (+75%) (SP2, GP104).

Often billed with

• K964 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: K964, K997, K994, K998, K992, E410

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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