CurrentEmpire BluecrossPolicy C-09005

Standby Services — Professional (nonreimbursable)

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This policy states Empire Bluecross' reimbursement stance for professional standby and hospital-mandated on-call services, and clarifies when related procedural services are eligible. It affects providers submitting claims to Empire Bluecross for professional standby/on-call services.

Policy Summary

PayerEmpire Bluecross

PolicyStandby Services — Professional (nonreimbursable)

Policy CodePolicy C-09005

Change TypeNo material change

Effective DateMay 5, 2026

Last ReviewMay 5, 2026

Next Review Date

Key ActionBill only for the specific service or procedure actually rendered following a standby period and ensure authorization and medical necessity requirements are met.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

nonreimbursablestandby and hospital-mandated on-call services

reimbursablespecific service or procedure rendered after standby

99026/99027/99360codes not eligible

99460/99465codes eligible

Coverage criteria — Standby and On‑Call Services

Coverage criteria — standby/on-call services

Covered when ALL of the following are met:

Empire Bluecross does not reimburse standby or hospital-mandated on-call services unless provider, state, or federal contracts and/or mandates indicate otherwise.

When the standby period ends with the provider rendering a specific service or procedure, do not separately reimburse the standby/on-call service; bill for the actual procedure or service performed.

ALL of the following

Examples of codes not eligible when billed in addition to newborn E/M or delivery resuscitation
- CPT 99360 (Standby service, requiring prolonged attendance, each 30 minutes) — not eligible for reimbursement when billed in addition to initial newborn E/M (99460) or delivery/birthing room resuscitation (99465).
Hospital-mandated on-call codes not eligible
- CPT 99026 (Hospital mandated on-call service; in-hospital, each hour) — not eligible for reimbursement.
- CPT 99027 (Hospital mandated on-call service; out-of-hospital, each hour) — not eligible for reimbursement.

Specific newborn and delivery/birthing room procedure codes are eligible for reimbursement when appropriately reported: CPT 99460 (initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant) and CPT 99465 (delivery/birthing room resuscitation) — these are reimbursable when billed for the actual services rendered.

CPT/Procedure Coding and Billing Rules

Not eligible for reimbursement (CPT)CPTNot Covered

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 (e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG) — Not eligible for reimbursement.

Eligible for reimbursement (CPT)CPTCovered

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 — Eligible for reimbursement.

Billing prohibition — standby/prolonged attendance

ProhibitionDo not reimburse prolonged attendance/standby codes when billed in addition to initial newborn E/M (CPT 99460) or delivery/birthing room resuscitation (CPT 99465).

Standby ending with procedureStandby services are nonreimbursable when the standby period ends with the provider rendering a specific procedure or service; bill for the actual procedure performed instead.

Hospital-mandated on-callHospital-mandated in-hospital or out-of-hospital on-call services (e.g., CPT 99026, 99027) are not eligible for reimbursement under this policy.

Examples of nonreimbursable codesCPT 99026, 99027, 99360 are listed as not eligible for reimbursement when subject to this policy.

Authorization, Documentation, and Claim Submission

Denial Risk

Authorization, documentation, and claim submission requirements; denial/recovery risk

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis. Use proper billing and submission guidelines with industry-standard CPT/HCPCS/revenue codes that are fully supported in the medical record; failure to follow coding/billing guidelines or current reimbursement policies may result in claim rejection, denial, or recovery/recoupment of payment.

Bill the specific service or procedure actually rendered following the standby period (do not bill standby if a procedure is performed — bill the procedure).
Ensure documentation in the medical record/office notes supports billed CPT/HCPCS/revenue codes.
Follow authorization and medical necessity requirements for the procedure and member’s state of residence.

Definitions — Standby Services

Standby Services — definition

DefinitionStandby Services: Professional physician services requested by another physician or health care provider that involve prolonged attendance without direct (face-to-face) patient contact.

Provider limitationDuring standby, the provider may not provide care or services to other patients.

Nature of serviceStandby involves presence and availability rather than active, direct patient management until a procedure or service is rendered.

Policy Summary

PayerEmpire Bluecross

PolicyStandby Services — Professional (nonreimbursable)

Policy CodePolicy C-09005

Change TypeNo material change

Effective DateMay 5, 2026

Last ReviewMay 5, 2026

Next Review Date

Key ActionBill only for the specific service or procedure actually rendered following a standby period and ensure authorization and medical necessity requirements are met.

SourceLink

On This Page

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Standby Services — Professional (nonreimbursable)

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Coverage criteria — Standby and On‑Call Services

Coverage criteria — standby/on-call services

Covered when ALL of the following are met:

Empire Bluecross does not reimburse standby or hospital-mandated on-call services unless provider, state, or federal contracts and/or mandates indicate otherwise.

When the standby period ends with the provider rendering a specific service or procedure, do not separately reimburse the standby/on-call service; bill for the actual procedure or service performed.

ALL of the following

Examples of codes not eligible when billed in addition to newborn E/M or delivery resuscitation
- CPT 99360 (Standby service, requiring prolonged attendance, each 30 minutes) — not eligible for reimbursement when billed in addition to initial newborn E/M (99460) or delivery/birthing room resuscitation (99465).
Hospital-mandated on-call codes not eligible
- CPT 99026 (Hospital mandated on-call service; in-hospital, each hour) — not eligible for reimbursement.
- CPT 99027 (Hospital mandated on-call service; out-of-hospital, each hour) — not eligible for reimbursement.

CPT/Procedure Coding and Billing Rules

Not eligible for reimbursement (CPT)CPTNot Covered

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 (e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG) — Not eligible for reimbursement.

Eligible for reimbursement (CPT)CPTCovered

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 — Eligible for reimbursement.

Billing prohibition — standby/prolonged attendance

ProhibitionDo not reimburse prolonged attendance/standby codes when billed in addition to initial newborn E/M (CPT 99460) or delivery/birthing room resuscitation (CPT 99465).

Hospital-mandated on-callHospital-mandated in-hospital or out-of-hospital on-call services (e.g., CPT 99026, 99027) are not eligible for reimbursement under this policy.

Examples of nonreimbursable codesCPT 99026, 99027, 99360 are listed as not eligible for reimbursement when subject to this policy.

Authorization, Documentation, and Claim Submission

Denial Risk

Authorization, documentation, and claim submission requirements; denial/recovery risk

Bill the specific service or procedure actually rendered following the standby period (do not bill standby if a procedure is performed — bill the procedure).
Ensure documentation in the medical record/office notes supports billed CPT/HCPCS/revenue codes.
Follow authorization and medical necessity requirements for the procedure and member’s state of residence.

Definitions — Standby Services

Standby Services — definition

DefinitionStandby Services: Professional physician services requested by another physician or health care provider that involve prolonged attendance without direct (face-to-face) patient contact.

Provider limitationDuring standby, the provider may not provide care or services to other patients.

Nature of serviceStandby involves presence and availability rather than active, direct patient management until a procedure or service is rendered.