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Billing code

U991A — Weekday daytime out-patient special visit premium, additional patients

Weekday out-patient call, more patients

Bill for each additional patient seen after the first on a non-elective weekday daytime (07:00 to 17:00) hospital out-patient call.

Watch for: Only eligible when a travel premium (U960) is payable for the trip; include the A-prefix assessment on the claim.

Code

U991A

Description

Weekday daytime out-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 patient seen in a hospital out-patient department, weekdays 07:00 to 17:00, on a non-elective call.

What it covers

U991 is the 'additional person(s) 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). The additional person premium is for further patients seen at the destination after the first, each started during the eligible times (GP66).

Billing rules

• On weekday daytimes, the patient-seen premiums are eligible only when a travel premium (U960) is payable for the trip, or with sacrifice of office hours (which has its own codes, U992 and U993) (GP66, GP71).
• Maximum 10 patients per time period for first and additional persons combined (GP71).
• Bill the A-prefix assessment from the General Listings with the premium (GP69).
• The time of the visit must be in the medical record (GP69).
• Not payable for patients seen on rounds, for elective admission assessments, for walk-in patients, or with emergency department H-prefix codes (GP65).
• No travel premium for moving between buildings on the same hospital campus (GP66).

Often billed with

• U960 travel premium and U990 first person seen premium for the same weekday daytime call (GP71).
• The A-prefix assessment or consultation for each patient (GP69).

Common rejections

• EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.
• AH8: OHIP's description is 'invalid admission date and/or hospital number'. Check the hospital number and any admission date on the claim.
• ADF: OHIP's description is 'required related procedure missing, invalid or paid at zero'. A special visit premium is only paid with an A-prefix assessment on the same claim (GP69), so check that the assessment is there and payable.
• EQ6: OHIP's description is 'referring provider number not registered with the Ministry'. Check the referring provider number on the claim.
• VJ7: OHIP received the claim more than three months after the service date (GP9). If it was first sent on time, use the stale-dated process.

Related codes: U990, U960, U992, U993, U994, U995

Source: Schedule of Benefits (July 1, 2026), General Preamble, Special Visit Premiums, pages GP65 to GP69 and Table II on GP71

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