< Billing codes

Billing code

U999A — Weekend/holiday out-patient special visit premium, additional patients

Weekend call, more patients

Bill for each additional out-patient seen after the first (U998) on a non-elective weekend or holiday call, 07:00 to 24:00.

Watch for: Maximum 20 patients per time period for U998 and U999 combined; bill the A-prefix assessment on the same claim.

Code

U999A

Description

Weekend/holiday 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 on a Saturday, Sunday or holiday, 07:00 to 24:00.

What it covers

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

It is billed for each patient seen at the destination after the first person (U998), 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 07:00 and 24:00 on a Saturday, Sunday or holiday (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).
• 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

• U998 first person seen on the same call (GP71).
• A003 general assessment or another A-prefix assessment for each patient (A4, GP69).

Related codes: U998, U963, U995, U997, C987, K999

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

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing