U964 – Travel Premium - Nights
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
A travel premium for a special visit to a hospital out-patient department. This premium is applicable for a non-elective visit initiated by a patient or their representative that commences during night hours (00:00-07:00). As defined on page , a travel premium is only eligible for payment for travel from one location to another (the destination). It is not eligible for payment when a physician travels within the same hospital complex or between buildings on the same hospital campus. Only one travel premium is payable for each separate trip to a destination, regardless of the number of patients seen. This premium must be claimed with an appropriate 'A' prefix assessment fee from the 'General Listings'.
When to Use
- Use U964 when you are called back to the hospital outpatient department for an urgent, non-elective assessment between 00:00 and 07:00.
- Apply this code when the patient encounter is initiated by the patient or staff after you have already left the hospital premises, distinguishing it from routine rounds.
Common Pitfalls
- Billing U964 for patients seen during routine hospital rounds or while already present in the facility for other duties will result in automatic rejection.
- Claiming U964 for travel between buildings on the same hospital campus is prohibited under GP66 and will be clawed back during an audit.
- Attempting to bill U964 for multiple patients seen during the same trip is a common error; only one travel premium is payable per trip regardless of patient volume.
Billing Tips
- Always pair U964 with an 'A' prefix assessment code (e.g., A007) to ensure the claim is processed correctly as a special visit.
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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