U997 – Additional person(s) seen
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
A special visit premium for an additional patient seen in a hospital out-patient department. This premium applies when a physician is called for a non-elective service and, after seeing the first patient, sees additional patients at the same location. The service for the additional patient must commence during the night period, defined as 00:00 hr to 07:00 hr. As per , special visit premiums are only eligible for payment when rendered with certain services listed under the 'Consultations and Visits' and 'Diagnostic and Therapeutic Procedures' sections. Claims must be submitted with the appropriate A-prefix assessment fee from the General Listings as per .
When to Use
- Use U997 for the second or subsequent patient seen during a non-elective night-time hospital out-patient visit after the initial patient has already triggered the primary special visit premium (e.g., U990 or U992).
- Apply this code when managing multiple emergency presentations in the hospital out-patient department between 00:00 and 07:00 that do not qualify as routine rounds.
Common Pitfalls
- Billing U997 for patients seen during routine hospital rounds or scheduled elective admissions, which are explicitly excluded under GP65.
- Attempting to claim U997 without an accompanying A-prefix assessment code, as the premium is strictly tied to the service fee for the additional patient.
- Submitting U997 for services rendered in a physician's private office or clinic that is typically open for business, even if the visit occurs during the night period.
Billing Tips
- Ensure the primary patient is billed with the appropriate initial special visit premium (e.g., U990) to establish the eligibility for the subsequent U997 claims.
- Clearly document the start and end times for each patient encounter to prove the service occurred within the 00:00 to 07:00 window and that the patients were seen sequentially.
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.
Submit claims using the appropriate A-prefix assessment fee from the “General Listings" for an assessment rendered in conjunction with a special visit premium.
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