U991 – Additional person(s) seen - Weekdays Daytime
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
This fee code represents a special visit premium for an additional person seen in a hospital out-patient department. It is applicable for non-elective services rendered on weekdays between 07:00 and 17:00. As defined in the of the Schedule, a special visit is a visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service. As per , an 'additional person premium' is eligible for payment for services rendered to additional patients seen in... outpatient departments... after the first patient, provided that each additional patient service is commenced during the eligible times. This specific premium, U991, applies to the 'Weekdays Daytime (07:00-17:00)' time period as specified in the Special Visit Premium Table II on page .
When to Use
- Use U991 when you are called to an outpatient department to see a second or subsequent patient for a non-elective service during weekday daytime hours.
- Apply this code when managing multiple patients in an outpatient setting who require urgent, non-elective assessment, provided the first patient was billed with the appropriate base assessment code.
Common Pitfalls
- Billing U991 for patients seen during routine hospital rounds is strictly prohibited and will result in claim rejection.
- Attempting to claim U991 for elective services or scheduled outpatient clinic visits is a common audit trigger, as the code is reserved for non-elective, urgent service requests.
- Failing to link U991 to a valid base assessment code (e.g., A007) will cause the premium to be denied.
Billing Tips
- Ensure the exact start time of the service is documented in the chart, as this is a mandatory requirement for all Special Visit Premiums under the General Preamble.
- Always bill the primary assessment code first, followed by U991, to ensure the system correctly recognizes the additional patient premium status.
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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