Author Topic: Office Visit Weekend Hours Code 99051  (Read 3503 times)


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Office Visit Weekend Hours Code 99051
« on: March 16, 2011, 03:04:31 PM »
We are using the 99051 code for weekend visits and not getting paid for it by Horizon BCBS, or any other major insurance carrier. 

I am hoping that you can help me try and make sure that we utilize this code correctly and begin to get reimbursed for it.  They allow for $38 per weekend visit on the EOBs but have used a number of remarks to deny paying for the service.  The denial remarks range from:
not eligible for separate reimbursement, denied because required modifier is missing (when modifier is placed, it says incorrect modifier), service is denied because it is excluded from members benefit plan.
Can you offer any help?  I am a medical billing service in New Jersey.  Thank you


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Re: Office Visit Weekend Hours Code 99051
« Reply #1 on: March 16, 2011, 08:39:42 PM »
First determine which circumstance applies:

CPT code 99051 is for services that are provided in the office during regularly schedule evening, weekend, or holiday hours.  EVENING beginning is normally 5pm

CPT code 99050 is for services that are provided in the office other than regularly scheduled office hours, or days that the office is normally closed.  Example: patient is seen OUTSIDE working hours for that practice OR a physicians is called in to see patient outside his/her schedule.   

These are ADD on code's which means that IF it's reimbursable it's going to be bundled with the E/M service. Medicare will not reimburse at all for it. Some carriers will and some won't.  I've seen carriers reimburse for 99050 but rarely for 99051.  Another factor is whether it's an appointment vs. walk-in.   Again, Medicare will not cover these.

Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers