U993 – Additional person(s) seen - Weekdays Evenings
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
This is a premium for an additional person seen during a special visit to a hospital out-patient department. It is payable for each non-elective patient seen after the first, when the service commences on a weekday between 17:00 and 24:00. This premium is claimed in addition to the appropriate A-prefix assessment fee.
When to Use
- Use U993 when you are already at the hospital out-patient department for a non-elective visit and are required to see a second or subsequent patient between 17:00 and 24:00 on a weekday.
- Apply this code when managing multiple non-elective patients in an out-patient setting during evening hours, provided the first patient was billed with the corresponding U992 premium.
Common Pitfalls
- Billing U993 without a corresponding U992 for the first patient will result in a rejection, as the additional person premium is contingent on the first patient visit.
- Claiming U993 for patients seen in an Emergency Department is a common error; those services must use the Table I Emergency Department premiums (e.g., K963) instead of Table II Out-Patient Department premiums.
- Failing to document the exact start time of the service in the medical record is a frequent cause for audit recovery, as the time determines eligibility for the evening premium window.
Billing Tips
- Ensure the service is strictly non-elective; elective follow-ups or scheduled out-patient procedures do not qualify for the U993 premium regardless of the time of day.
- Always pair U993 with the appropriate A-prefix assessment code (e.g., A007) to ensure the base service and the premium are processed correctly.
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.
An additional person premium is only eligible for payment for services rendered at the destination to additional patients seen in emergency departments, outpatient departments, long-term care institutions or to hospital inpatients, provided that each additional patient service is commenced during the eligible times.
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