CurrentUnitedHealthcarePolicy N/A

After hours and weekend care (CPT codes 99050–99060) reimbursement

This UnitedHealthcare reimbursement policy governs separate payment for after-hours and weekend care CPT codes on CMS-1500 (and electronic equivalent) for UnitedHealthcare Commercial and Individual Exchange benefit plans and applies to all network and non-network physicians and other qualified health care professionals.

Policy Summary

PayerUnitedHealthcare

PolicyAfter hours and weekend care (CPT codes 99050–99060) reimbursement

Policy CodePolicy N/A

Change TypeAdministrative / template and guideline updates

Effective DateN/A

Next Review DateMay 25, 2025

Key ActionParticipating primary care providers will be reimbursed for CPT codes 99050 and 99051 when reported in specified CMS non‑facility places of service and when provider type is among listed primary care specialties/providers.

SourceLink

POLICY UPDATE CHANGES

Transferred content to shared policy template that applies to both UnitedHealthcare Commercial and Individual Exchange benefit plans and updated Application section to indicate applicability to all UnitedHealthcare Commercial benefit plans.

Policy logo updated and reimbursement guidelines updated to add Physician Assistant.

Entries prior to 8/1/2021 archived in history section.

99050, 99051after-hours codes allowed for separate reimbursement

99053/56/58/60codes not separately reimbursed

Commercial & Exchangeplans covered

CMS-1500claim form

Coverage Criteria

Coverage criteria for after-hours/weekend CPT codes

UnitedHealthcare reimbursement stance for CPT codes 99050–99060 and conditions when 99050/99051 are reimbursed:

UnitedHealthcare follows CMS guidance regarding separate reimbursement for after-hours and weekend care CPT codes.

CPT codes 99053, 99056, 99058, and 99060 are not separately reimbursed.

ALL of the following

Allowed POS (one of)
- School (CMS POS 03)
- Indian Health Service Free-standing Facility (CMS POS 05)

Policy Summary

PayerUnitedHealthcare

PolicyAfter hours and weekend care (CPT codes 99050–99060) reimbursement

Policy CodePolicy N/A

Change TypeAdministrative / template and guideline updates

Effective DateN/A

Next Review DateMay 25, 2025

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.

Codes and Place of Service

Covered CPT CodesCPTCovered

99050	After hours/weekend care by physician — reimbursed in addition to basic services in specified POS for participating primary care providers
99051	After hours/weekend care in addition to acute care services (not preventive) — reimbursed in specified POS for participating primary care providers

Not separately reimbursed CPT CodesCPTNot Covered

99053	Non-reimbursed after hours/weekend care code
99056	Non-reimbursed after hours/weekend care code
99058	Non-reimbursed after hours/weekend care code
99060	Non-reimbursed after hours/weekend care code

Allowed POS for additional reimbursement

Allowed place of service (POS) for additional reimbursementSchool (CMS POS 03); Indian Health Service Free‑standing Facility (CMS POS 05); Tribal 638 Free‑Standing Facility (CMS POS 07); Office (CMS POS 11); Independent Clinic (CMS POS 49); State or Local Public Health Clinic (CMS POS 71); Federally Qualified Health Center (CMS POS 50); Rural Health Clinic (CMS POS 72)

Applies to after‑hours CPT codesReimbursement in these POS designations applies to CPT codes 99050 and 99051 for participating primary care providers

POS designations are CMS non‑facilityThese are specified CMS non‑facility place of service codes for which additional reimbursement may be provided

LimitationReimbursement in these POS applies only to participating primary care providers as defined in the policy

Provider Billing and Reimbursement Actions

Billing Rule

Reimbursement for CPT 99050 and 99051

Participating primary care providers may bill CPT 99050 (after hours/weekend care in addition to basic services) and CPT 99051 (after hours/weekend care in addition to acute care services) for services rendered outside regular posted office hours or on days the office is normally closed when reported in the specified non-facility CMS POS designations for reimbursement. Reimbursement is intended for participating primary care providers as an alternative to more costly emergency or urgent care services.

99050 reimbursed during times other than regularly scheduled office hours or on days the office is normally closed, in addition to basic service.
99051 reimbursed for regularly scheduled evening services, in addition to acute (non-preventive) care services.
Reimbursement applies to participating primary care providers and is intended to encourage care outside higher-cost settings.

Denial Risk

Non‑reimbursed after‑hours codes (99053, 99056, 99058, 99060)

UnitedHealthcare will not separately reimburse CPT codes 99053, 99056, 99058, or 99060, consistent with CMS; these codes are not paid because they would not accomplish the policy purpose of reimbursing participating primary care providers for after-hours care as an alternative to higher-cost settings.

Codes 99053, 99056, 99058 and 99060 are not separately reimbursed by UnitedHealthcare.
The policy aligns with CMS guidance that these codes are not reimbursed for the stated purpose of after-hours/weekend care.

OpenPayer

After hours and weekend care (CPT codes 99050–99060) reimbursement

Coverage Criteria

Codes and Place of Service

Provider Billing and Reimbursement Actions

Definitions