What are the billing rules for U997A?

Each additional patient's service must start between 00:00 and 07:00 (GP66). No maximum number of patients per time period (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 U997A often billed with?

U996 first person seen on the same night call (GP71). U964 travel premium when the physician travels to the hospital (GP71). A003 general assessment or another A-prefix assessment for each patient (A4, GP69).

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Billing code

U997A — Night out-patient special visit premium, additional patients

Q: What is OHIP billing code U997A?

Special visit premium for each additional out-patient seen on a non-elective hospital out-patient call at night, 00:00 to 07:00. No maximum per period.

Night call, more patients

Bill for each additional out-patient seen after the first (U996) on a non-elective night call, 00:00 to 07:00.

Watch for: Each patient's service must start between 00:00 and 07:00; bill the A-prefix assessment on the same claim.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$102.80	$0.00	$0.00	$0.00	$0.00

Code: U997A
Description: Night 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 on a non-elective hospital out-patient call at night, 00:00 to 07:00. No maximum per period.

What it covers

U997 is the 'additional person(s) seen' premium in Special Visit Premium Table II, Hospital Out-Patient Department, for nights 00:00 to 07:00 (GP71).

It is billed for each patient seen at the destination after the first person (U996), when each additional service starts during the night period (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 00:00 and 07:00 (GP66).
No maximum number of patients per time period (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

U996 first person seen on the same night call (GP71).
U964 travel premium when the physician travels to the hospital (GP71).
A003 general assessment or another A-prefix assessment for each patient (A4, GP69).

Related codes: U996, U964, U995, U999, C997, K997

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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