Wiki 99053 After Hours Codes

[jmoswald]

We have physicians that are billing the after hours codes with the office visits which is ok but the insurance companies arent paying them. Does anyone know the guidelines as far as when this is appropriate to bill? I have looked in the coding desk reference and the CPT book and cannot find anything. Any information is helpful. Thank you

Jamie

 

[ollielooya]

Jamie, this may be payer-policy driven and we've had similar issues. We bill 99058 and have limited sucess on getting those paid. More often than not, they are denied for bundling. IF the payer policy has stated that they will pay, it's worth appealing based on that rationale. Not sure about MCR and the governmental payers, but doubt they will pay. I am looking at a Cigna policy right now that states they will NOT pay. ---Suzanne E. Byrum

 

[mitchellde]

99050 is for visits that occur when the office is ordinarily closed.
99053 are for services between 10pm and 8am in a 24 hour facility.
If you are using the wrong one then it will not work. I have many payors pay the 99050 as well as the 99058 which is for an emergency encounter in the office that disrupts other scheduled services. When these have not paid I have been able to win on appeal. Just make sure you are using them correctly.