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After Hours and Weekend Care Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans

Overview

After hours or weekend care (CPT®) codes represent services provided, when an individual physician or other health care professional is required to render the services outside of regular posted office hours to treat a patient's urgent illness or condition. This policy outlines when after hours or weekend care codes are considered for separate reimbursement.

Policy Codes

Find your specific codes below.

This policy contains more codes than can be displayed on one screen. Find your specific code below.

Enter your code here As you input 2 or more characters, a clear button becomes available, and codes will dynamically display below. The number of returned codes will decrease as you enter more characters.

  • 99050
  • 99051
  • 99053
  • 99056
  • 99058
  • 99060
* COMM-After-Hours-Weekend-Care-Policy.pdf
Click to Download: After Hours and Weekend Care Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans

Questions and Answers

Q: Why doesn't UnitedHealthcare provide reimbursement for CPT codes 99053, 99056, 99058 or 99060?

A: The After Hours and Weekend Care policy is intended to reimburse participating primary care providers for services that are outside their regular posted business hours as an alternative to more costly emergency room or urgent care center services. Reimbursement for CPT codes 99053, 99056, 99058 or 99060 would not accomplish this purpose and are not reimbursed by CMS.

Q: When will UnitedHealthcare provide reimbursement for CPT code 99050?

A: UnitedHealthcare will provide reimbursement for CPT code 99050 during times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service.

Q: When will UnitedHealthcare provide reimbursement for CPT code 99051?

A: UnitedHealthcare will provide reimbursement for CPT code 99051 during regularly scheduled evening, weekend, or holiday office hours, in addition to acute care services (not preventive medicine services).