Summary & Overview
CPT 99026: Hospital On-Call Availability, One Hour
CPT code 99026 documents a provider’s one-hour, on-call availability at a hospital under a formal agreement. This time-based availability code matters nationally because it formalizes compensation for providers who are required to be immediately available to perform services on short notice, supporting hospital staffing models and emergency coverage arrangements.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context and common use cases, an explanation of typical sites of service, and the payer landscape covered. The publication outlines common modifiers associated with the code and notes areas where documentation and billing practices typically require attention.
The report is intended for billing managers, hospital administrators, and clinicians involved in call coverage arrangements. It covers national benchmarks and payer practices where available, relevant policy considerations affecting reimbursement for on-call availability, and practical documentation points tied to the code’s time-based nature. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 99026 describes when a provider makes themself available to perform services in a hospital on an on-call or as-needed basis for a period of one hour, in fulfillment of an agreement with that facility. This code represents a time-based availability service rather than direct patient care and is classified as a hospital on-call availability service.
-
Service type: On-call/hospital availability
-
Typical site of service: Hospital
Clinical & Coding Specifications
Clinical Context
A hospital arranges on-call coverage for surgical and medical services and contracts with a physician to be available for immediate consultation or to perform procedures as needed. For example, a general surgeon signs an agreement to provide on-site availability for emergency laparotomies and consultations between 7:00 PM and 8:00 PM while the hospital is short-staffed. During that hour the surgeon remains reachable and able to present to the facility within the agreed response time. If the physician provides this one-hour period of availability in fulfillment of the facility agreement, the service is documented and billed as 99026 for the hour of on-call availability. Typical workflow: the physician documents the date, start and end time of the on-call hour, the contractual basis for coverage, the facility served, and any immediate clinical actions taken (consultation, evaluation, or procedure) during or immediately following the on-call interval.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard service | Used when no specific modifier applies to the on-call hour |
22 | Increased procedural services | Rarely applicable; used if the on-call period required substantially greater effort beyond usual availability terms