Standby Services - Professional
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This policy governs reimbursement for professional standby or hospital-mandated on-call services for Blue Cross Blue Shield - Wisconsin commercial plans; it specifies when standby services are non-reimbursable and clarifies related coding and exemptions.
No material clinical or coverage changes in this revision.
Standby Service Coverage Rules
Standby services coverage rules
Covered when ALL of the following are met:
Related CPT/HCPCS Codes and Reimbursement Eligibility
| 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 — 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 Provider Reimbursement Stance
Do not bill standby/on-call codes unless contract/mandate requires reimbursement
The health plan does not allow reimbursement for standby or hospital-mandated on-call services unless overridden by provider, state, or federal contracts or mandates. If the standby period ends with the provider rendering a specific service or procedure, the plan will reimburse only for that specific service or procedure — not for the standby code itself.
- Standby codes (including prolonged attendance codes) are non-reimbursable when billed in addition to initial E/M for a normal newborn or delivery/birthing room resuscitation.
- Hospital-mandated in-hospital or out-of-hospital on-call services are not eligible for reimbursement unless a contract or mandate requires otherwise.
Terminology — Standby Services
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