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Wiki after hours

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Isabel Casaus

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Hi i would like more information on using the after hours and other scheduling based codes (99050, 99051, 99053 and 99058). The clinic I work for just started using these codes, as of this date the insurance companies have not paid for 99050. can you give me more info on this to report back to pediatric physicians.
 
Most insurance companies to not pay for these "add on codes". What I would suggest is check with the insurance companies (probably a sampling of your top 5 payors) to see what their medical policies are regarding these codes. You can usuallly access them online and they will provide you with detailed information on each code.
 
As a learning experience and since our doctor treats patients that fit the criteria to bill 99058, I decided to go after payment for this code. I was told in the beginning that few paid and resources spent trying to recover the small amount paid would outweigh the revnue generated. But again, as a test, and on my own time, decided to go after it. Even found a major insurance company that published a directive that said they would pay it, but two years later after fighting and appealing and still fighting, don't seem any closer to getting this code paid. It irks me that they're policy states one thing, but they haven't honored it. Smaller insurance companies have paid it and every now and then one sneaks thru from one of the major carriers and not sure how to explain especially when we've been informed they will NOT pay. Haven't used the other codes, only the 99058 so hope others may be able to give you an answer. Revenue from the 99058 has been anywhere from $35.00 to $10.00 so it's not a whole lot. Good luck!

Suzanne E. Byrum CPC
Noridian-WA
Palmetto-NV
 
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