U996 – First person seen - Hospital Out-Patient Department - Nights
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
This is a special visit premium for the first person seen by a physician for a non-elective service in a hospital out-patient department. The visit must commence during the night period, defined as 00:00h to 07:00h. This premium is paid in addition to an eligible assessment from the General Listings ('A' prefix codes) and any applicable travel premium (U964). As per the rules on , a special visit is one initiated by a patient or their representative for a non-elective service. Documentation of the time of the visit is required. There is no maximum limit on the number of these services per time period.
When to Use
- Use U996 when you are called into the hospital outpatient department between 00:00 and 07:00 to assess a patient for a non-elective, urgent issue.
- Use this code when the patient's arrival and your attendance are initiated by the patient or their representative, distinct from your routine rounds or scheduled clinic hours.
Common Pitfalls
- Billing U996 in conjunction with 'H' prefix emergency department codes will result in an automatic rejection, as these are mutually exclusive.
- Claiming U996 for patients seen during routine hospital rounds or scheduled night-time clinic hours is a common audit trigger for non-compliance with the 'special visit' definition.
- Failing to document the exact start time of the visit in the medical record is a frequent cause for recovery during OHIP audits.
Billing Tips
- Always pair U996 with the appropriate 'A' prefix assessment code (e.g., A007) and, if applicable, the U964 travel premium for a single trip.
- If you see subsequent patients during the same night-time trip, bill U997 for those additional patients instead of repeating U996.
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.
Special visit means a visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service or, if rendered in the patient's home, a non-elective or elective service.
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