United Healthcare (UHC) announces changes in their reimbursement policies in their monthly bulletin and in the July Bulletin they posted a change for procedure code 99051.
CPT code 99051 is 'Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service' which is now reimbursable by UHC when billed by primary care provider's (PCP's) with acute services effective August 18th, 2018. This policy change allows patients to more conveniently see their own physician while reimbursing physicians for having 'unusual' office hours.
UHC already allows reimbursement on 99050 'Services provided in the office at 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' which gives providers additional reimbursement when seeing patients on their 'day off'. Neither CPT 99050 or 99051 give exact times as to what qualifies for evenings or what days are holidays so as always, check with each insurance carrier to find out their requirements.
Both of these codes could help reduce the amount of urgent care and emergency room (ER) visits as patients could see their regular provider, avoid the high cost of urgent care or the ER and providers will get a little boost in reimbursement for providing these services to the patient. Not all insurances will reimburse these codes like UHC, but hopefully more insurances will follow in an effort to reduce the high cost patients incur at urgent care and ER's while directing more payments to PCP's.
