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99051, Modifier 25?

  1. Default 99051, Modifier 25?
    Medical Coding Books
    Has anyone had success using CPT code 99051 for evening office hours? In addition to the office visit code, supposedly some plans will reimburse for this code which is described as services provided during regularly scheduled evening, weekend or holiday office hours in addition to basic service. It is not an add on code though. So does a modifier 25 go on the office visit?

  2. #2
    Default 99051
    No need for modifier 25. We use this code for our after-hours clinics and some insurances do cover. Depends mainly on ins. contracts and pts personal plans.


  3. #3
    we can not use additional 25 mod for cpt 99051, hence it is after hour sevices , some prayer may paid for that ie 25 mod
    dr dadhich sunil

  4. #4
    BC/BS (in Virginia) does not reimburse 99051 - their provider rep advised us to use 99050 - they consider "after hours" to be after their hours of operation, which is 5pm - strange, I know... (If you're in VA, I can give you her contact number)

    We were using 99051 (which I swear they've paid before, but they insist they don't, or they shouldn't at least.) and then all of the sudden they just stopped - which brought upon the issue.

    As far as modifier 25, it shouldn't be used on this code or the E/M code. It's billed "in addition to basic service" - which is normally your E/M. (this is just if the E/M is billed and the after hours - you might use 25 on the E/M if there's a procedure involved)

    Hope this helps

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