U995 – Additional person(s) seen
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
U995 is an additional person seen premium, payable for a non-elective special visit to a hospital out-patient department. It applies to each additional patient seen after the first, provided the service for that patient begins between 07:00 and 24:00 on a Saturday, Sunday, or Holiday. As per , a special visit is initiated by a patient or their representative for a non-elective service. This premium must be claimed with an appropriate assessment from the General Listings ('A' prefix codes) as stated on .
When to Use
- Use U995 when you assess a second or subsequent patient in a hospital outpatient department during a non-elective visit on a weekend or holiday between 07:00 and 24:00.
- Apply U995 when managing multiple patients during a single trip to the hospital for non-elective care, provided the first patient was billed with the appropriate primary special visit premium (e.g., U991 or U993).
Common Pitfalls
- Billing U995 with 'H' prefix emergency department codes will result in an automatic rejection, as it is strictly for hospital outpatient department settings.
- Claiming U995 for the first patient seen is a common error; it is only payable for the second and subsequent patients encountered during the same special visit.
- Failure to document the exact time of the visit for each patient can lead to audit recovery, as the time must validate the weekend or holiday premium window.
Billing Tips
- Ensure the primary patient is billed with the correct base special visit premium (e.g., U991) to establish the visit, then append U995 to the subsequent patient assessments.
- Always pair U995 with an 'A' prefix assessment code from the General Listings to ensure compliance with GP69 requirements.
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.
U995 is an 'Additional person(s) seen' premium for a non-elective visit to a hospital out-patient department during Saturdays, Sundays, and Holidays (07:00-24:00).
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