Urology Coding Alert

Question: In the May 2006 Urology 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 Physician Fee Schedule.


Montana Subscriber

Answer: You're not going to 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 do not 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 for 99050. Medicare has assigned no relative value units 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, especially if the patient does not have to be seen in an emergency department.

Several insurance carriers such as Aetna, UnitedHealthcare, and Humana will pay between $12 and $30 for this extra service. But they will not pay for this service if radiological or other minor procedures are also performed and billed during the same encounter.