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Billing code

U998A — Weekend/holiday out-patient special visit premium, first patient

Weekend or holiday out-patient premium

Bill for the first patient seen on a non-elective out-patient call on a Saturday, Sunday or holiday, 07:00 to 24:00.

Watch for: After midnight use the night premium U996 instead; bill the A-prefix assessment on the same claim.

Code

U998A

Description

Weekend/holiday 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

Premium for the first patient seen in a hospital out-patient department on a non-elective special visit on a Saturday, Sunday or holiday, 07:00 to 24:00.

What it covers

U998 is the 'first person seen' premium in Special Visit Premium Table II, Hospital Out-Patient Department, for Saturdays, Sundays and holidays, 07:00 to 24:00 (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 call are billed with U999 (GP71).

Billing rules

• The service must start between 07:00 and 24:00 on a Saturday, Sunday or holiday; after midnight the night premium U996 applies (GP66, GP71).
• Maximum 20 patients per time period for U998 and U999 combined (GP71).
• Holidays are the days defined on GP3; only services listed as holiday premiums or services, such as certain special visit premiums and after-hours premiums, are paid as holiday claims (GP3).
• A travel premium isn't required on weekends and holidays; U963 (maximum 6 per time period) is added only when the physician travels to the hospital (GP66, 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

• U999 for each additional out-patient seen on the same call (GP71).
• U963 travel premium, maximum 6 per time period (GP71).
• A003 general assessment or another A-prefix assessment for the patient (A4, GP69).

Related codes: U999, U963, U994, U996, C986, K998

Source: Schedule of Benefits (July 1, 2026), General Preamble, Special Visit Premiums, pages GP65 to GP69 and Table II on GP71; holidays GP3

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