U994 – First person seen - Sat., Sun. and Holidays (07:00-24:00)
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
U994 is a 'first person seen' special visit premium for a non-elective service rendered in a hospital out-patient department. It is applicable when the service for the first patient commences on Saturdays, Sundays, and Holidays (07:00-24:00). All special visit requirements as outlined in the Schedule of Benefits (see pages -) must be met, including documentation of the time of the visit in the medical record. Claims for the associated assessment should use an A-prefix code from the 'General Listings' (). This premium is for the first patient seen on a special visit and is subject to usage limits per time period.
When to Use
- Use U994 when you are specifically called into the hospital out-patient department for a non-elective assessment on a weekend or holiday during the 07:00-24:00 window.
- Apply this code when the patient is the first person seen during that specific call-out, provided the service is not rendered in the Emergency Department (where Table I codes like U960 would apply instead).
Common Pitfalls
- Billing U994 for services provided in the Emergency Department, which is a common rejection as Table II premiums are strictly for out-patient department settings.
- Failing to document the exact start time of the service in the chart, which is a mandatory requirement for all Special Visit Premiums and a frequent target for Ministry audits.
- Attempting to claim U994 for subsequent patients seen during the same call-out, as this premium is strictly limited to the first patient seen.
Billing Tips
- Ensure the associated assessment code is an A-prefix code from the General Listings, as using non-qualifying assessment codes will trigger an automatic rejection of the premium.
- Verify that the service is truly non-elective; if the visit was pre-scheduled or elective, the claim for U994 will be clawed back upon review.
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.
The fee listed for this service in the Special Visit Premium Table II on page is $60.00.
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