tci Medicare Compliance & Reimbursement - 2015 Issue 21
Reader Question: Don't Count on Pay for 99051
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Article Overview
This reader Q&A explains how pediatric practices should think about special services billing when adding temporary evening and weekend office hours. It discusses the distinction between routine scheduled hours and after-hours office availability, notes that payer policies may differ, and highlights coverage concerns tied to preventive versus problem-oriented visits. The article is useful for coders, billers, and practice managers who need a general understanding of special services code usage and insurer policy issues.
Why This Topic Matters
Temporary schedule changes can affect which special services code a practice considers and whether payers will reimburse it. Understanding the general distinction between routine office hours and outside-hours services helps reduce billing errors and payer denials.
What You Will Learn
- How special services billing is discussed when a practice adds temporary evening and weekend hours
- Why payer policies can affect coverage of special services codes
- How coverage considerations may differ between preventive visits and problem-oriented visits
- Why office scheduling practices matter for billing in pediatric settings
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Pediatric office administrators
Codes Discussed
Code Ranges Discussed
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