Cpt 99051

Can someone please explain to me 99051. I have a family practice interested in this code but there are many different opinions on how it is supposed to be used. Is it for the scheduled patient after 5:00 or the patient that comes in same day without a scheduled appointment?

99051

The fact that a code exists does not mean that payors are required to reimburse for it. CPT code 99051 used when you provide services "during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service. It is an adjunct code. Evening hours are generally considered to start at 5 p.m but it depends on payer interpretation. This code compensates your practice for the additional costs of being open extended hours. Not all payors will reimburse you for this code, but some payors may recognize the value and cost of these services and reimburse for this code (don't hold your breath). Check the policies of each of your payors to see if you can receive compensation from them. There is no need to check Medicare's policy, though: Medicare will never reimburse for this code, they consider it Bundled (cannot bill Medicare or the patient).

99051

We are having no problems billing 99051 claims are being paid you can always try it see what happens

Modifier needed for 99051?

Is a modifier needed on an office visit in order to use this code? We have received notification from one of our ins. companies that they will pay for this code.

nope

we bill it without modifier and my billing staff has not told me to add one.

no modifier needed

Because it is an add on code, you don't use a modifier.

Payment, as Nancy said, will vary.