U990 – First person seen
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
`U990` is a premium for the 'first person seen' during a special visit to a Hospital Out-Patient Department. This premium is applicable for non-elective services rendered during Weekdays Daytime hours (07:00-17:00). A 'special visit' is defined on page as a visit initiated by a patient or representative for a non-elective service. Per , this daytime first person seen premium is only eligible for payment in circumstances where a travel premium (U960) is also payable. As per , claims must be submitted with an appropriate A-prefix assessment code.
When to Use
- Use U990 when you are called into the hospital outpatient department for an urgent, non-elective assessment during weekday daytime hours (07:00-17:00) and you qualify for the U960 travel premium.
- Apply this code when performing an initial assessment on a patient who requires an immediate, non-elective evaluation that cannot wait for your next scheduled clinic session.
Common Pitfalls
- Billing U990 without an accompanying U960 travel premium will result in an automatic rejection, as the daytime premium is strictly contingent on travel eligibility.
- Attempting to claim U990 for elective services or routine follow-ups will lead to audit recovery, as the service must meet the strict definition of a non-elective special visit.
- Using a non-A-prefix assessment code (such as a K-code or C-code) will cause the claim to fail, as the General Preamble mandates an A-prefix assessment for this premium.
Billing Tips
- Ensure your claim includes both the A-prefix assessment code and the U960 travel premium on the same submission to satisfy the mandatory linkage requirements for the U990 premium.
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.
This premium is part of Special Visit Premium Table II for Hospital Out-Patient Department services.
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