Optometry Coding & Billing Alert

Published on Sat Apr 26, 2008 PDF

Question: Where can I find the allowed charge amount for after-hours appointment code 99050? I can't find the code in the Medicare physician fee schedule.

Montana Subscriber

Answer: You won't find reimbursement amounts for 99050 (Services provided in the office at times other than regularly scheduled office hours ...) on the Medicare physician fee schedule because Medicare payers won't reimburse for after-hours codes 99050-99053.

Medicare has assigned a "bundled" status to 99050. This means that insurers will bundle payment for this service into payment for other services not specified (such as 99201-99215).

Good news: You can sometimes persuade private payers to reimburse for these services. You may be able to convince private carriers to pay by showing how after-hours visits -- on an emergency basis -- can benefit patients and, at the same time, reduce the cost of claims. You may want to ask your state optometric association to pursue this issue on your behalf with private insurance carriers.