What are the billing rules for U995A?

Each additional patient's service must start between 17:00 and 24:00 on a weekday (GP66). Maximum 10 patients per time period for U994 and U995 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).

What is U995A often billed with?

U994 first person seen on the same evening call (GP71). A003 general assessment or another A-prefix assessment for each patient (A4, GP69). A933 on-call admission assessment, with E082 when the physician is the MRP, when the patient is admitted non-electively. If a family physician's out-patient consultation, general assessment or general re-assessment leads to the admission, that visit is itself the admission assessment (A7, GP41, GP42).

Why is U995A rejected?

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.

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Billing code

U995A — Weekday evening out-patient special visit premium, additional patients

Q: What is OHIP billing code U995A?

Special visit premium for each additional out-patient seen in a hospital out-patient department on a non-elective call, Monday to Friday 17:00 to 24:00.

Weekday evening call, more patients

Bill for each additional out-patient seen after the first (U994) on a non-elective call, Monday to Friday 17:00 to 24:00.

Watch for: Bill the A-prefix assessment on the same claim; maximum 10 patients per time period for U994 and U995 combined.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$61.70	$0.00	$0.00	$0.00	$0.00

Code: U995A
Description: Weekday evening 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 out-patient seen in a hospital out-patient department on a non-elective call, Monday to Friday 17:00 to 24:00.

What it covers

U995 is the 'additional person(s) seen' premium in Special Visit Premium Table II, Hospital Out-Patient Department, for evenings 17:00 to 24:00, Monday to Friday (GP71).

It is billed for each patient seen at the destination after the first person (U994), when each additional service starts during the eligible times (GP66). A special visit is one initiated by the patient, or someone on their behalf, for a non-elective service (GP65).

Billing rules

Each additional patient's service must start between 17:00 and 24:00 on a weekday (GP66).
Maximum 10 patients per time period for U994 and U995 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

U994 first person seen on the same evening call (GP71).
A003 general assessment or another A-prefix assessment for each patient (A4, GP69).
A933 on-call admission assessment, with E082 when the physician is the MRP, when the patient is admitted non-electively. If a family physician's out-patient consultation, general assessment or general re-assessment leads to the admission, that visit is itself the admission assessment (A7, GP41, GP42).

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: U994, U962, U991, U997, U999, C995

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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