U961 – Travel Premium - Weekdays Evenings
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
U961 is a travel premium payable for a special visit to a hospital out-patient department, as detailed in Special Visit Premium Table II on page . This premium is applicable when a physician makes a non-elective visit during weekdays (Monday to Friday, 17:00-24:00). Key Conditions: - Special Visit Definition: The visit must be initiated by or on behalf of the patient for the purpose of rendering a non-elective service (). - Sacrifice of Office Hours: A previously unscheduled non-elective visit causes a scheduled office visit with another patient to be delayed or cancelled (). - Travel Requirement: The premium is only payable for travel from one location to another destination. It is not payable for travel within the same hospital complex (). Claims Submission & Documentation: - Claims must be submitted with an appropriate A-prefix assessment fee from the General Listings (). - The time of the special visit must be documented in the medical record ().
When to Use
- Use U961 when you are called away from your office during the 17:00-24:00 weekday window to attend a non-elective hospital outpatient visit, resulting in the cancellation or delay of scheduled office patients.
- Use U961 when you are already at home or another location and must travel to the hospital outpatient department for an urgent, non-elective patient assessment during the specified evening hours.
Common Pitfalls
- Billing U961 for patients seen during routine hospital rounds or elective admissions, which are strictly excluded under the General Preamble.
- Attempting to claim U961 when traveling between different buildings within the same hospital complex, as this does not meet the travel requirement.
- Submitting U961 alongside 'H' prefix emergency department codes, which are restricted and will result in a claim rejection.
Billing Tips
- Ensure you link U961 to an appropriate A-prefix assessment code (e.g., A007) and explicitly document the exact time of the visit in the patient record to satisfy audit requirements.
- Remember that U961 is per trip; if you see multiple patients during the same hospital visit, you can only claim the travel premium once.
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.
Sacrifice of office hours means an insured service rendered when the demands of the patient and/or the patient's condition are such that the physician makes a previously unscheduled non-elective visit to the patient at a time when the physician had an office visit booked with one or more patients but, because of the previously unscheduled non-elective visit, any such office visit was delayed or cancelled.
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