• UnitedHealthcare to expand payment for after-hours primary care

    One of the nation’s largest insurers is expanding payment for primary care provided after hours or on the weekends.

    UnitedHealthcare (UHC) says it will begin on Aug. 18 paying for CPT code 99051 (service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service). UHC already pays code 99050 for primary care services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed, such as holidays or the weekend.

    Medicare and some other payers bundle 99050 and 99051 into the payment for other services provided on the same day. UHC’s decision to pay code 99050 recognizes that having patients seen in the primary care setting in situations that might otherwise require costlier urgent care or emergency room service is valuable. Payment for code 99051 further recognizes that primary care practices with additional hours provide a convenient way for members to see their own physicians.

    UHC will pay after-hours codes 99050 and 99051 to participating primary care physicians when reported with basic services in one of the following non-facility place of service (POS) designations only:

    •    School (POS 03)
    •    Indian Health Service Free-standing Facility (POS 5)
    •    Tribal 638 Free-Standing Facility (POS 7)
    •    Office (POS 11)
    •    Independent Clinic (POS 49)
    •    Federally Qualified Health Center (POS 50)
    •    State or Local Public Health Clinic (POS 71)
    •    Rural Health Clinic (POS 72)

    No word yet on whether Medicare or other payers will follow UHC’s lead and change their payment policies on after-hours care.

    – Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

    Posted on Jun 15, 2018 by Kent Moore

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.