Medicare Compliance & Reimbursement

Question: Our practice has decided to stay open this Labor Day, and we’ve let our patients know about these extra hours ahead of time. Do we report CPT^® code 99050 along with an E/M code for the holiday hours?

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Answer: No. One of the biggest sources of confusion on this issue occurs when practices try to decide to apply 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service) or 99051 (Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) for services outside of regular office hours or during holidays.

In this case, providers will see patients during regularly advertised hours, so 99050 cannot apply. Instead, you will need to use 99051 in addition to an E/M service code from 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) because your providers will see patients during holiday hours that your practice has posted.

“You can only use 99050 for patients scheduled outside of your posted business hours,” says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

Consider this example: Your office has posted hours of 8:00 AM to 6:00 PM Monday through Friday, and 8:00 AM to 12:00 PM on Saturdays. A provider then sees a patient at 2:00 PM on Saturday afternoon. In this scenario, 99050 would be the correct code choice to use with an E/M office code, as the physician provided the service after the practice had closed.