U998 – First person seen - Daytime with Sacrifice of Office Hours
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
This is a special visit premium for the first person seen in a hospital out-patient department. It is payable for a non-elective service initiated by a patient or their representative during daytime (07:00-17:00) when the service requires sacrifice of office hours. Sacrifice of office hours means an insured service rendered when the demands of the patient and/or the patient's condition are such that the physician makes a previously unscheduled non-elective visit to the patient at a time when the physician had an office visit booked with one or more patients but, because of the previously unscheduled non-elective visit, any such office visit was delayed or cancelled. This premium is claimed in addition to an appropriate A-prefix assessment fee from the General Listings. The time of the visit must be documented in the medical record as per . A travel premium (U963) may also be applicable for the same visit.
When to Use
- Use U998 when you must leave your office during daytime hours to attend a non-elective hospital outpatient consultation, resulting in the cancellation or delay of your scheduled office patients.
- Apply this code when you are called to the hospital for an urgent, non-elective assessment that interrupts your private office practice, provided it is the first patient seen during that specific trip.
Common Pitfalls
- Do not bill U998 if you are already at the hospital for other scheduled work, as the premium specifically requires the sacrifice of office hours.
- Avoid billing U998 in conjunction with 'H' prefix emergency department codes, as these are explicitly restricted under the General Preamble.
- Failure to document the exact start time of the visit in the medical record is a frequent cause for audit recovery, as it must prove the visit occurred during the claimed timeframe.
Billing Tips
- Always pair U998 with an appropriate A-prefix assessment code (e.g., A007) to ensure the claim is processed correctly as a special visit.
- If you see subsequent patients during the same trip, use U999 for the additional patients rather than repeating U998.
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.
A first person seen premium is eligible for payment for the first person seen at the destination during the eligible times.
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