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Neurosurgery Coding Alert

Reader Question:

Medicare Won't Recognize 'After Hours'

Published on Thu Jan 01, 2004

Question: A Medicare patient knocked on the door on a Friday when the office was closed. He was concerned that some medication the physician prescribed was having an adverse effect. The physician agreed to see the patient and performed an E/M service. May we report 99050 in addition to an office visit?

South Carolina Subscriber Answer: Code 99050 (Services requested after posted office hours in addition to basic service) is listed as a "Status B" code in the Medicare fee schedule. This means that CMS has not assigned any relative value units to this service, and 99050 is always bundled to any other E/M service the physician provides. Therefore, Medicare will not pay you for use of this code. Because Medicare is the payer in the scenario described, you may bill only the E/M code.
 
Some commercial insurance companies, however, will reimburse for 99050. Physician practices will often negotiate this code as part of their fee schedule with commercial payers.
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