U963 – Travel Premium - Daytime with Sacrifice of Office Hours
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
This is a travel premium for a non-elective special visit to a patient in a hospital out-patient department. It applies to services rendered during daytime hours (07:00-17:00) with sacrifice of office hours. A special visit is defined as a visit initiated by a patient or on their behalf for a non-elective service. This travel premium is payable once per trip to the destination, regardless of the number of patients seen, and must be claimed with an appropriate assessment code (usually an 'A' prefix code).
When to Use
- Use U963 when you are called away from your private office during daytime hours to perform a non-elective assessment in a hospital out-patient department.
- Use this code when the service is urgent and requires an immediate departure from your office, effectively sacrificing your scheduled patient appointments.
Common Pitfalls
- Billing U963 for patients seen during routine hospital rounds is a common audit trigger, as special visit premiums are strictly prohibited for scheduled rounds.
- Claiming U963 alongside 'H' prefix emergency department codes will result in an automatic rejection, as these services are mutually exclusive.
- Failing to document the exact time of the visit in the medical record is a frequent cause of claim clawbacks during Ministry audits.
Billing Tips
- Ensure you only claim one U963 per trip to the hospital, even if you assess multiple patients during that single visit to the out-patient department.
- Always pair U963 with an appropriate 'A' prefix assessment code, as the premium is only payable when linked to a valid service code.
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.
Submit claims using the appropriate A-prefix assessment fee from the 'General Listings' for an assessment rendered in conjunction with a special visit premium.
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