Urgent Care Reimbursement for CPT 99050 and 99051
This document governs reimbursement for urgent care services billed with CPT codes 99050 and 99051 when provided by specified provider types to CareSource PASSE members; it affects participating providers including physicians, nurse practitioners, hospitals, RHCs, and FQHCs in the PASSE network.
No material clinical or coverage changes in this revision.
Coverage Criteria for After-Hours Urgent Care
Reimbursement criteria for urgent care after-hours/evening services
Coverage is provided when services are billed with CPT codes 99050 or 99051 by eligible provider types and are for non-emergent urgent care outside of primary care office hours.
ALL of the following
Provider type
- Physician (Medicaid Provider Type PT-01)
- Nurse Practitioner (PT-58)
- Hospital (PT-05)
- Rural Health Clinic (PT-29)
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