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Billing code

U996A — Night out-patient special visit premium, first patient

Night out-patient premium

Bill for the first patient seen on a non-elective hospital out-patient call starting at night, 00:00 to 07:00, any day.

Watch for: Bill the A-prefix assessment or consultation on the same claim, and record the time of the visit.

Code

U996A

Description

Night 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

Special visit premium for the first patient seen in a hospital out-patient department on a non-elective call that starts at night, 00:00 to 07:00.

What it covers

U996 is the 'first person seen' premium in Special Visit Premium Table II, Hospital Out-Patient Department, for nights 00:00 to 07:00 (GP71). It pays for the first patient seen at the destination when the service starts in that period (GP66).

A special visit is one initiated by the patient, or someone on their behalf, for a non-elective service (GP65). Further out-patients seen on the same night call are billed with U997 (GP71).

Billing rules

• The service must start between 00:00 and 07:00, any day of the week (GP66, GP71).
• No maximum number of patients per time period (GP71).
• A travel premium isn't required at night; U964 is added only when the physician travels to the hospital (GP66, GP71). No travel premium for moving between buildings on the same hospital campus (GP66).
• 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

• U997 for each additional out-patient seen on the same night call (GP71).
• U964 travel premium, no maximum per time period (GP71).
• E410 (+75%) on the procedural fee for a qualifying non-elective procedure started at night (SP2, GP103 to GP104).

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: U997, U964, U994, U998, C996, K996, E410

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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