After-hours and weekend professional services reimbursement
Defines when Premera Blue Cross recognizes and reimburses CPT after-hours and weekend professional services (99050–99060) for applicable lines of business; applies to professional claims submitted on CMS-1500/837P and affected products.
Clarified the first paragraph regarding reimbursement of these codes and added the 'Codes/Coding Guidelines' section listing 99050–99060.
Added cross reference to Facility Fees Policy.
Clarified the Purpose statement to indicate policy pertains to professional services billed on CMS-1500 or 837P claims.
After-hours and Weekend Reimbursement Criteria
After-hours/weekend reimbursement criteria
Reimbursement policy for after-hours/weekend professional CPT codes
Applicable CPT Codes
| 99050 | Services provided in the office at times other than regularly scheduled office hours or days when the office is normally closed, 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 |
| 99053 | Services provided between 10:00pm and 8:00am at 24-hour facility, in addition to basic service |
| 99056 | Services typically provided in the office, provided out of the office at the request of patient, in addition to basic service |
| 99058 | Services provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service |
| 99060 | Services provided on an emergency basis, out of the office, which disrupts other scheduled office services, in addition to basic service |
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