U999 – Additional person(s) seen - Daytime with Sacrifice of Office Hours
OHIP Other Code — GENERAL PREAMBLE · Schedule of Benefits
U999 is an 'additional person seen' special visit premium. It is payable for each additional patient seen after the first during a special visit to a hospital out-patient department. This premium applies when the service is rendered during daytime hours (07:00h-17:00h) with sacrifice of office hours. A special visit must be initiated by a patient or their representative for a non-elective service. The claim must be submitted with an appropriate 'A' prefix assessment fee from the General Listings.
When to Use
- Use U999 for the second and subsequent patients seen during a single trip to the hospital out-patient department when you have already billed the first patient's premium (e.g., U990-U994).
- Apply this code when you are called in for multiple non-elective assessments during daytime hours (07:00-17:00) that force you to sacrifice your scheduled office hours.
Common Pitfalls
- Billing U999 for patients seen during routine hospital rounds, which is strictly prohibited under the General Preamble.
- Failing to link U999 to an 'A' prefix assessment code, which will result in an automatic rejection.
- Attempting to bill U999 in conjunction with H-coded hospital visit fees, as these are mutually exclusive with special visit premiums.
Billing Tips
- Ensure the start and end times of the visit are clearly documented in the chart to justify the 'sacrifice of office hours' requirement during the daytime window.
- Always pair U999 with the appropriate 'A' prefix assessment code (e.g., A007) to ensure the claim meets the mandatory service requirement.
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.
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