Neurology & Pain Management Coding Alert

Question: How do I get paid for after-hours visits?

Illinois Subscriber

Answer: Unfortunately, payment for 99050-99054 (services required after office hours in addition to basic service) is very carrier-specific. If it is a managed care plan, the neurologist can negotiate for reimbursement in the contract. You should ask your top-five payers which ones will pay. You must also find out if there are any conditions regarding their use, for example, the place of service should be the neurologists office. If the physician cannot obtain payment for these visits, the patients should be informed that this service cannot be offered because it is not reimbursed.