99050 and 99051 CPT codes
The 99050 and 99051 CPT codes are used when client care extends beyond traditional office hours. Life doesn't always adhere to 9-to-5 weekday hours.
Clients receiving mental health services, for example, may need immediate support or experience crises, prompting them to seek services outside of regular business hours.
The realities of life, including school schedules and demanding jobs, also lead many patients to seek appointments at convenient times during weekends or evenings.
Summary
- CPT 99050 is used for services provided outside regular office hours (e.g., holidays, weekends when the office is closed), while CPT 99051 is for services during regularly scheduled evening, weekend, or holiday hours.
- Both codes are add-ons to a primary service code (like 90834) and should reflect the time and reason care was given outside typical hours.
- Reimbursement varies by payer. Therapists should verify coverage, document medical necessity, and clearly define practice hours to support appropriate billing. Enrolling in an insurance billing course for therapists can help providers enhance their knowledge.
- Overusing these codes or applying them inconsistently without clear policies and documentation can lead to denials, audits, and strained client relationships. By leveraging an EHR like TheraPlatform for efficient documentation and claim submission, therapists can tackle billing with ease.
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Providers who offer after-hours and weekend care should be familiar with the appropriate associated billing practices. CPT Codes 99050 and 99051 are intended to account for the additional cost and provider inconvenience of off-hours care.
Using these CPT codes correctly is the key to successful reimbursement and ethical billing. Follow along as we explore the specifics of CPT 99050 and 99051. We'll delve into when and how to use these codes effectively in private practice, discuss how to navigate insurance considerations and offer practical application tips.
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CPT 99050: Additional fee for services outside regular office hours
The official code description of CPT 99050 is:
"Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays or weekends), in addition to basic service."
CPT 99050 is used as an add-on to a primary service code to reflect appointment timing outside of regularly scheduled office hours. If your practice's typical hours of operation are Monday through Friday from 9 a.m. to 5 p.m., any service outside these hours would be eligible for this code's application.
Private practices can use this code to accommodate clients who seek care outside of the typically 9-to-5 office hours and obtain appropriate reimbursement for the costs and inconvenience associated with after-hours care.
CPT 99051: Additional fee for services during evenings/weekends
CPT 99051 is also an add-on code for services, but the timing of the service it applies to is more specifically stated:
"Services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service."
This code applies to private practices that offer evening or weekend hours as part of their regular schedule.
For example, if a practice is open until 8 p.m. and a client books a session at 7 p.m., the CPT code 99051 would be more appropriate than CPT 99050.
The code CPT 99051 acknowledges that the service was provided during the practice's traditional business hours while recognizing the value of providing care outside those hours.
The key distinction between CPT 99050 and 99051 is whether the service occurred outside the provider's posted and regular schedule (CPT 99050) or within the extended hours they already offer (CPT 99051).
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When to use these codes in private practice
CPT codes 99050 and 99051 might be used by mental health providers in the following scenarios:
- Emergency sessions: A client may experience an acute mental health crisis that requires immediate intervention, which may fall outside of regular office hours. In this situation, CPT 99050 can be billed in addition to the regular service code for the primary service.
- Late-hour accommodations: Many clients work during traditional business hours and must schedule therapy services during evening or weekend hours. If your practice regularly offers extended hours to accommodate clients, the CPT code 99051 can be used in billing.
- Holiday sessions: If the provider offers availability on a holiday and the office is typically closed, it may be appropriate to use CPT 99050 when billing for a session that occurs.
- Intensive treatment programs: Some private practices offer intensive programs that extend beyond standard daily hours or may include weekends. CPT 99051 may be appropriate to use in this scenario.
Insurance and reimbursement considerations
Providers should consider keeping these key considerations in mind when navigating insurance reimbursement for CPT 99050 and 99051:
- Medical necessity: Insurance companies often look for documentation that shows the services provided outside of regular hours were medically necessary.
- Payer coverage: Certain insurance plans may not cover CPT 99050 and 99051 or may be reimbursed at a reduced rate.
- Billing order: These codes should be listed in addition to the primary service code for the service.
- Prior verification: To determine coverage, it is essential to verify benefits with each insurance provider before billing these CPT codes.
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Documentation for CPT codes 99050 and 99051
Thorough and accurate documentation is essential for billing, including the use of CPT Codes 99050 and 99051.
To support the use of these codes, consider including these components in your clinical notes or billing records:
- Date and time of service: Document the service's exact start and end time. This supports appointments after hours or on weekends.
- Justification: Note why the session had to occur outside of regular business hours (e.g., schedule accommodation, client crisis).
- Primary Service Code: Remember that 99050 and 99051 are add-on codes that must accompany a primary service code. Be sure to document this primary service code (e.g., 90834), which the clinical content of the session should support.
Practice hours
While therapists may not reflect this in the session note, regular office hours should be established and documented somewhere, such as within your practice's policy. This serves as a context for what would be considered "after hours."
Tips for using CPT codes 99050 and 99051
- Establish clear policies: Set regular operating hours for your practice. Document and communicate this with clients and staff to clarify why CPT 99050 and 99051 are used.
- Track denials: Monitor how various payers reimburse for these codes. This allows you to determine which payers consistently reimburse or deny, guiding ongoing billing practices.
- Utilize a practice management system: Platforms such as TheraPlatform help practice owners easily document appointment times, apply CPT codes, and streamline the billing process.
Challenges and what to avoid
- Inconsistent policies: Without clear office hours, payers may challenge CPT 99050 versus 99051, and some payers don’t reimburse for these codes at all.
- Lack of communication: If you do not communicate in advance with clients that they may be charged more for a weekend or evening session, they may resist this.
- Overuse/misuse: Do not apply these codes to every weekend or evening session unless it meets the outlined criteria. This can lead to claim denials or audits.
CPT codes 99050 and 9905 offer valuable ways for providers to receive appropriate compensation for the effort and availability required to provide care outside traditional business hours.
Payer policies vary, however, thorough documentation, strong client communication, and clearly defined office hours can help facilitate the use of these codes.
How EHR and practice management software can save you time with insurance billing for therapists
EHRs with integrated billing software and clearing houses, such as TheraPlatform, offer therapists significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
Watch this video to see how TheraPlatform’s EHR saves time on insurance billing
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers
Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.
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More resources
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References
Burks, K., Shields, J., Evans, J., Plumley, J., Gerlach, J., & Flesher, S. (2022). A systematic review of outpatient billing practices. SAGE Open Medicine, 10, 20503121221099021.
DOI: https://journals.sagepub.com/doi/full/10.1177/20503121221099021
Derricks, J. (2021). Overview of the claims submission, medical billing, and revenue cycle management processes. In The Medical-Legal Aspects of Acute Care Medicine: A Resource for Clinicians, Administrators, and Risk Managers (pp. 251-276). Cham: Springer International Publishing. https://link.springer.com/chapter/10.1007/978-3-030-68570-6_11
Ellis, D. A., Sanders, J. G., Jenkins, R., & McAuslan, L. (2022). A weekday intervention to reduce missed appointments. Plos one, 17(9), e0274670. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0274670
FAQs about CPT codes 99050 and 99051
What is the difference between CPT 99050 and CPT 99051?
CPT 99050 is used when services occur outside a practice’s regularly scheduled hours or when the office is normally closed, while CPT 99051 applies to services delivered during scheduled evening, weekend, or holiday hours.
Can CPT 99050 and 99051 be billed alone?
No. Both are add-on codes and must be billed alongside a primary service code, such as a psychotherapy CPT code.
Are CPT 99050 and 99051 always reimbursed by insurance?
Not always. Reimbursement varies by payer, so therapists should verify coverage, document medical necessity, and clearly define practice hours to reduce denials.
