CurrentFlorida BluePolicy 10-002

After Hours and Weekend Care

Defines Florida Blue's reimbursement policy for physicians billing additional payment for after-hours and weekend office services (CPT codes 99050 and 99051) on CMS-1500 or equivalent claim forms; applies to providers billing Florida Blue across all lines of business.

Policy Summary

PayerFlorida Blue

PolicyAfter Hours and Weekend Care

Policy CodePolicy 10-002

Change TypeClarification

Effective DateMar 25, 2025

Next Review Date

Key ActionBill after-hours and weekend office services on a CMS-1500 or equivalent claim form; report CPT codes 99050 and 99051 in addition to the basic service when eligible.

SourceLink

POLICY UPDATE CHANGES

Clarifying language added to indicate this policy applies to billing for services on a CMS-1500 or equivalent claim form.

2Separately reimbursable codes (99050, 99051)

4Not separately reimbursable (99053, 99056, 99058, 99060)

5:00 PMEvening hours defined as after

CMS-1500Claim form specified

When After-Hours and Weekend Services Are Reimbursed

After-hours/weekend reimbursement criteria

Reimbursement conditions

CPT codes 99050 and 99051 are reimbursable in addition to the basic service when the basic service being rendered is eligible for reimbursement.

CPT codes 99053, 99056, 99058 and 99060 are not separately reimbursable and are considered included in the allowance of other services.

Services must be billed on a CMS-1500 or equivalent claim form (same provider defined by Federal Tax ID).

Operational requirement: bill on CMS-1500 or equivalent and the claim must represent services by the same provider tax ID.

Evening hours are defined as after 5:00 PM.

Policy Summary

PayerFlorida Blue

PolicyAfter Hours and Weekend Care

Policy CodePolicy 10-002

Change TypeClarification

Effective DateMar 25, 2025

Next Review Date

Key ActionBill after-hours and weekend office services on a CMS-1500 or equivalent claim form; report CPT codes 99050 and 99051 in addition to the basic service when eligible.

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.

CPT Codes and Time Thresholds

Covered CPT codesCPTCovered

99050	Services provided in the office at times other than regularly scheduled office hours, in addition to basic service
99051	Services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service

Not separately reimbursable / Included CPT codesCPTNot Covered

99053	Services provided between 10:00 PM and 8:00 AM at 24-hour facility; not separately reimbursable per policy
99056	Services typically provided in the office, provided out of the office at request of patient; considered included
99058	Services provided on an emergency basis in the office which disrupt other scheduled office services; considered included
99060	Services provided on an emergency basis, out of the office, which disrupt other scheduled office services; considered included

Evening hours threshold

Evening hours thresholdAfter 5:00 PM

Applies to reimbursement for CPT codes99050 and 99051 when basic service is eligible for reimbursement

Billing contextUsed when reporting after-hours or weekend office services in addition to the basic service

Billing Requirements and Reimbursement Actions

Billing Rule

Billing requirement: Use CMS-1500/equivalent and same Federal Tax ID

Bill after-hours and weekend office services on a CMS-1500 or equivalent claim form. For this policy, “same provider” includes all physicians and other health care professionals reporting under the same Federal Tax Identification number.

Use CMS-1500 or equivalent claim form for after-hours/weekend office services.
Ensure billing is submitted under the same Federal Tax Identification number to meet the “same provider” requirement.

Note

Report 99050/99051 in addition to basic service (evening = after 5:00 p.m.)

Report CPT codes 99050 and 99051 in addition to the basic service when the basic service is eligible for reimbursement; evening hours are defined as after 5:00 p.m.

Submit 99050 and 99051 only in addition to the reimbursable basic service.
Do not separately bill CPT codes 99053, 99056, 99058, or 99060 (they are considered included).
Evening hours threshold: after 5:00 p.m.

Key Terms

Same provider — definition

Definition of 'Same provider'Includes all physicians and/or other health care professionals reporting under the same Federal Tax Identification number

ScopeApplies for determining which providers may report after-hours/weekend services on the claim

Billing requirement relationUsed in conjunction with CMS-1500 or equivalent claim form instructions in this policy

Evening hours — definition

Evening hours — definitionAfter 5:00 p.m.

Context for CPT 99051Services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service

Relation to reimbursementEvening hours definition is used to determine eligibility to report CPT codes 99050 and 99051 in addition to the basic service