Can You Get Paid for Seeing Patients After Hours?
- Lindsay Everson
- Oct 26, 2020
- 2 min read
Do you ever open your practice during off hours to see a patient who has an emergency? Or, do you stay beyond closing time to treat someone who calls last minute? Did you know there are two CPT codes that can be used to capture these and, potentially, increase your income?
CPT 99050 reads: services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays, Saturday or Sunday), in addition to basic service
CPT 99051 reads: Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service
The verbiage for the usage of 99050 is pretty clear- use this code in addition to the E&M code(s) you use when you have seen a patient during a time the practice is normally closed.
The wording for 99051 is a little more vague. Most insurers, as a general rule, consider 5pm as the start of evening hours. However, if your business hours are posted and you're open until 7pm, you may not use this code for any patient seen prior to the closing time.
Some general rules apply to both codes:
CMS does not pay either of these codes.
If the scheduled appointment starts before you close and runs over time, 99051 does not apply.
Make sure you document that you either opened the practice or you stayed late in order to see the patient. Also, make a note that you saw the patient for acute care in lieu of them going to urgent care or the emergency room; this helps show the insurers the savings.
United Healthcare does not reimburse 99051 if used in conjunction with preventive medicine codes (99381-99397). You must use an office visit code for acute care (99201*-99215).
If you have any questions regarding these codes, contact us at www.PremierMBMA.com.
*99201 will be deleted from the E&M code set effective 1/1/21.
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