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Billing code

U992A — Weekday out-patient special visit premium, office hours sacrificed, first patient

Out-patient call, office hours sacrificed

Bill for the first patient seen on a non-elective weekday daytime out-patient call that delayed or cancelled booked office visits.

Watch for: At least one booked office visit must have been delayed or cancelled; otherwise bill U990 with a travel premium.

Code

U992A

Description

Weekday out-patient special visit premium, office hours sacrificed, 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 that sacrifices office hours.

What it covers

U992 is the 'first person seen' premium in Special Visit Premium Table II, Hospital Out-Patient Department, for weekday daytime (07:00 to 17:00) with sacrifice of office hours (GP71).

Sacrifice of office hours means the physician makes a previously unscheduled non-elective visit at a time when office patients were booked, and at least one of those office visits was delayed or cancelled because of it (GP65). A special visit is one initiated by the patient, or someone on their behalf, for a non-elective service (GP65).

Billing rules

• Only when office patients were booked and the call delayed or cancelled at least one of those visits (GP65). Without that, a weekday daytime call is U990, which needs a travel premium (GP66, GP71).
• Sacrifice of office hours is its own basis for the first person seen premium; a travel premium isn't required (GP66).
• Maximum 10 patients per time period for U992 and U993 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).

Often billed with

• U961 travel premium (maximum 2 per time period) when the physician travels to the hospital for the call (GP71).
• U993 for each additional out-patient seen on the same call (GP71).
• A003 general assessment, or another A-prefix assessment, for the patient (A4, GP69).

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: U993, U961, U990, U994, C992, C989, K992

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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