CurrentAnthemPolicy C-09005

Standby Services - Professional

Defines Anthem's reimbursement stance for professional standby and hospital-mandated on-call services for commercial members and explains billing expectations and exceptions for services rendered following standby periods.

Policy Summary

PayerAnthem

PolicyStandby Services - Professional

Policy CodePolicy C-09005

Change TypeNo material changes

Effective DateMay 4, 2009

Next Review Date

Key ActionDo not bill or expect reimbursement for standby or hospital-mandated on-call services unless contracts or mandates indicate otherwise.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

99026, 99027, 99360Standby/on-call nonreimbursable codes

99460, 99465Perinatal codes reimbursable

05/04/2009; 11/16/2022Policy dates

Participating & non-participatingProvider applicability

Standby Services Coverage Criteria

Standby Services coverage criteria

Anthem does not reimburse standby or hospital‑mandated on‑call services except where provider, state, or federal contracts/mandates indicate otherwise. Reimbursement is allowed for the specific service or procedure actually rendered following the standby period.

Standby or hospital‑mandated on‑call services are nonreimbursable unless provider, state, or federal contract or mandate indicates otherwise.

When the standby period ends with the provider rendering a specific procedure or service, the standby service itself is nonreimbursable; the subsequent specific procedure or service may be reimbursed per its own rules.

The prolonged attendance (standby) code may not be billed in addition to the initial Evaluation and Management code for a normal newborn (e.g., 99460) or delivery/birthing room resuscitation (e.g., 99465).

Specific codes

Policy Summary

PayerAnthem

PolicyStandby Services - Professional

Policy CodePolicy C-09005

Change TypeNo material changes

Effective DateMay 4, 2009

Next Review Date

Key ActionDo not bill or expect reimbursement for standby or hospital-mandated on-call services unless contracts or mandates indicate otherwise.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Standby and Related Perinatal Codes

Standby and related perinatal codesCPT

99026	Hospital mandated on call service; in-hospital, each hour - Not eligible for reimbursement
99027	Hospital mandated on call service; out-of-hospital, each hour - Not eligible for reimbursement
99360	Standby service, requiring prolonged attendance, each 30 minutes (eg, operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG) - Not eligible for reimbursement
99460	Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant - Eligible for reimbursement
99465	Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output - Eligible for reimbursement

Billing and Prior Authorization Expectations

Prior Authorization

Prior authorization and reimbursement stance for standby/on-call services

Do not bill or expect reimbursement for standby or hospital-mandated on-call services unless a provider, state, or federal contract or mandate specifically overrides this policy. Reimbursement is allowed only for the specific service or procedure actually rendered following the standby period. Claims for standby services may be denied, rejected, or recouped if billing, authorization, medical necessity, or documentation requirements are not met.

Standby services are nonreimbursable when the standby period ends with the provider rendering a specific procedure or service.
The prolonged attendance (standby) code may not be billed in addition to the initial E/M for a normal newborn or delivery/birthing room resuscitation.
Hospital-mandated in-hospital or out-of-hospital on-call services (e.g., codes 99026, 99027, 99360) are not eligible for reimbursement unless overridden by contract/mandate.

Definitions

Standby Services — definition and implications

DefinitionProfessional physician services requested by another physician or health care provider involving prolonged attendance without direct (face-to-face) patient contact; provider may not provide care to other patients during this period.

ContextTerm used within Anthem reimbursement policies to describe services that are generally nonreimbursable unless overridden by provider, state, or federal contracts/mandates.

Billing implicationStandby services are typically not reimbursed; providers should not bill for prolonged attendance codes unless policy exceptions apply.

Provider expectationWhen standby ends and a specific service/procedure is rendered, reimbursement is allowed only for the specific service per its own rules—not for the standby period itself.

DocumentationClaims for services following standby must be supported by medical record documentation and meet authorization and medical necessity guidelines.