U960 – Travel Premium - Hospital Out-Patient Department
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
A travel premium for a non-elective special visit to a patient in a Hospital Out-Patient Department, as defined in Special Visit Premium Table II on page . This premium compensates for the travel to the location for a visit initiated by a patient or their representative. It is applicable for services rendered on weekdays (Monday to Friday) between 07:00 and 17:00. As per , only one travel premium is payable per trip, regardless of the number of patients seen, and it is not payable for travel within the same hospital complex.
When to Use
- Use U960 when you are called back to the hospital outpatient department for a non-elective, urgent assessment during the weekday window of 07:00 to 17:00.
- Apply this code when you must travel from your private office to the hospital to see a patient in the outpatient department, provided the visit was initiated by the patient or their representative.
Common Pitfalls
- Billing U960 for patients seen while you are already physically present in the hospital for routine rounds or scheduled clinic hours will result in a rejection.
- Attempting to claim U960 for travel between buildings within the same hospital complex is prohibited; only one travel premium is payable per trip regardless of the number of patients seen.
- Submitting U960 without an accompanying A-prefix assessment code (e.g., A007) will cause the claim to fail as the premium requires a base service.
Billing Tips
- Ensure the exact time of the special visit is clearly documented in the medical record, as this is a mandatory requirement for audit compliance.
- If you see multiple patients during a single trip, you may only claim one U960 travel premium, but you can claim the 'First Person Seen' premium (e.g., K960) in addition to the base assessment fee for each patient.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table II - Hospital Out-Patient Department)
The time at which the special visit takes place must be documented on the medical record.
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