Billing code
U990A — Weekday daytime out-patient special visit premium, first patient
Weekday out-patient call premium
Bill for the first patient seen on a non-elective weekday daytime (07:00 to 17:00) hospital out-patient call when a travel premium applies.
Watch for: Bill it with the U960 travel premium and an A-prefix assessment; without an eligible trip it isn't payable.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $20.55 | $0.00 | $0.00 | $0.00 | $0.00 |
- Code
- U990A
- Description
- Weekday daytime out-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
Premium for the first patient seen in a hospital out-patient department on a non-elective weekday daytime special visit, when a travel premium applies.
What it covers
U990 is the 'first person seen' premium in Special Visit Premium Table II, Hospital Out-Patient Department, for weekday daytime (07:00 to 17:00) (GP71).
A special visit is one initiated by the patient, or someone on their behalf, for a non-elective service (GP65). On a weekday daytime, a first person seen premium is eligible only when a travel premium is payable for the trip (GP66); in the out-patient table that is U960.
Billing rules
- Bill with U960 travel premium (maximum 2 per time period); without an eligible trip, U990 is not payable on a weekday daytime (GP66, GP71).
- No travel premium for moving between buildings on the same hospital campus (GP66).
- Maximum 10 patients per time period for U990 and U991 combined (GP71).
- Not payable for non-referred or transferred obstetrical patients, for a visit that pays critical care team fees, or with emergency department H-prefix codes (GP65).
- Bill the A-prefix assessment or consultation from the General Listings with the premium (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).
- For a non-elective surgical procedure started 07:00 to 17:00 on a weekday, the surgeon claims the consultation (if referred) or assessment, the special visit premium and the procedure (SP2).
Often billed with
- U960 travel premium for the trip (GP71).
- U991 for each additional out-patient seen on the same call (GP71).
- A035 consultation, A935 special surgical consultation or A034 partial assessment (General Surgery) as the A-prefix service (A107, GP69).
- A non-elective surgical procedure done on the call, such as anoscopy Z543: the surgeon claims the consultation (if referred) or assessment, the premium and the procedural benefit (SP2).
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: U991, U960, U992, U994, U998, U996, C990, K990
Source: Schedule of Benefits (July 1, 2026), General Preamble, Special Visit Premiums, pages GP65 to GP69 and Table II on GP71; Surgical Preamble SP2
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