Wiki Tri Care ins

[blufrogg]

My question is we as a pediatric office are having problems getting Tricare to pay for the after hours code 99051. What our insurance team found was if we put the 99213-25 and the 99051-59 with other small procedures Tricare said they would Pay but, we are finding that is not working either. If you know of how we need to be using modifiers with an E&M, After hours and other small procedures i.e JCodes for therapeutic inj. let us know please we are stuck on how to get the 99051 after hours paid for.

Thank you,
Chris and Dawn

 

[MarcusM]

https://www.unitedhealthcareonline....imbursementPolicies/AH_After Hours_v2011A.htm. Has good info on after hours. Tricare will follow CMS as described in here. Essentially states after hours is included in primary services...