HMSA’s QUEST plan recognizes the use of three after-hours modifier codes:
| CPT Code | Description |
|---|---|
| 99050 | Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays, Saturday or Sunday), in addition to basic service. |
| 99053 | Service(s) provided requested between 10 p.m. and 8 a.m. at 24-hour facility in addition to basic service. |
| 99060 | Service(s) provided on an emergency basis, out of the office, which disrupts other scheduled office services, in addition to basic service. |
Criteria for Use
- Only one of the three codes may be billed. They may not be billed together.
- Documentation must appear on the claim and medical record that includes the time the service was rendered and the special circumstances that required the use of this code.
- These codes may only be used if the provider makes a special trip outside of established office hours to the hospital or office to treat a patient.
Limitations/Exclusions
- After-hours codes cannot be used for routine hospital rounds, even though the visits occur after regular office hours.
- After-hours codes may not be used by physicians staffing emergency rooms.
Claims Filing Instructions
Example
The hospital calls a physician at home because one of his or her patients is in crisis. (It is 2 a.m.). The physician decides to go to the hospital to direct the hospital staff in treating the patient. The claim should be completed as follows:
Sample Claim Form
