Ophthalmology and Optometry Coding Alert

Question: In the July 2006 Ophthalmology Coding Alert, an article addresses using 99050 for after-hours appointments. Where can I find the allowed charge amount? I can't find the code in the Medicare Fee Schedule?

 

Montana Subscriber

 

Answer: You won't find reimbursement amounts for 99050 (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) on the Medicare Physician Fee Schedule because Medicare payers won't reimburse for -after-hours- codes 99050-99053.

     
Medicare has assigned a -bundled- status to 99050. This means that payment for this service is always bundled into payment for other services not specified (such as 99201-99215), and you shouldn't expect separate payment. Medicare has assigned no relative value units (RVUs) or payment amount for these codes.

           
Good news: You can sometimes persuade private payers to reimburse for these services. You may be able to convince private carriers to pay by showing how after-hours visits -- on an emergency basis -- can benefit patients and, at the same time, reduce the cost of claims.