Reimbursement policy update: After-Hours, Emergency, and Miscellaneous E/M Services – Professional

Beginning with dates of service on or after January 1, 2024, the After-Hours, Emergency, and Miscellaneous E/M Services – Professional reimbursement policy will also apply to facility providers. The intent of this policy is to reimburse professional providers for rendering urgent services outside of regular hours (“after hours” services) when such services are:

• Billed on a CMS-1500 form.
• Billed with an office place of service (POS 11).
• Rendered between 5:00 p.m. and 8:00 a.m. on weekdays or anytime on weekends based on arrival time and not the actual time the service commenced.

The policy will not allow separate reimbursement for “after hours” codes 99050 or 99051 when:

• Billed by facility providers.
• Billed with POS 20 (urgent care facility).

The policy will be retitled After-Hours, Emergency, and Miscellaneous E/M Services – Professional and Facility.

For specific policy details, visit anthem.com and select For Providers. Under the Provider Resources heading, select Policies, Guidelines & Manuals. On the next screen, select the Select a State. Next, under the Reimbursement Policies heading, select Access policies.