After Hours and Weekend Care
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Governs Healthfirst reimbursement stance for CPT after-hours/weekend service codes 99050 and 99051 across multiple Healthfirst lines of business; affects participating providers submitting claims for these services.
No material clinical or coverage changes in this revision.
Coverage and Bundling Rules
Bundling and denial criteria
Healthfirst will not separately reimburse CPT codes 99050 and 99051; these are considered bundled per CMS.
After-Hours / Weekend Visit Codes and Status
| 99050 | Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays, Saturday or Sunday), 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. |
Claim Adjudication and Appeal Actions
Claim adjudication and appeals: denial and corrected claims timely filing
If claims are submitted with CPT codes 99050 or 99051, those claim lines will be denied. Providers who submit corrected claims must meet timely filing requirements specified in their provider contract and the Healthfirst Provider Manual (see Subsection 17.6).
Definitions and Abbreviations
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.