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CPT® Code 99051 refers to services that are rendered in an office setting during specific times that are outside of the standard office hours. This includes services provided during regularly scheduled evening hours, weekends, or holidays. The code is utilized to indicate that the service provided is in addition to the basic service that would typically be offered during regular office hours. The designation of this code highlights the unique circumstances under which the service is delivered, acknowledging the additional effort and resources required to accommodate patients during these non-standard times. It is important for medical coders and billers to recognize that this code is specifically for situations where services are rendered outside of the usual office hours, ensuring proper documentation and billing for the additional services provided to patients during these times.
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The use of CPT® Code 99051 is indicated for services provided in the office during non-standard hours, which include regularly scheduled evening hours, weekends, or holidays. This code is applicable when patients require medical attention during these times, necessitating the availability of healthcare services beyond the typical office hours. The following conditions may warrant the use of this code:
The procedural steps associated with CPT® Code 99051 involve the following:
After the services have been rendered under CPT® Code 99051, the healthcare provider should ensure that the patient receives appropriate follow-up instructions, if necessary. This may include scheduling further appointments, providing prescriptions, or advising on any additional care needed. It is also important to review the documentation to confirm that all services provided during the non-standard hours are accurately recorded for billing purposes. Patients should be informed about any potential costs associated with services rendered during these hours, as they may differ from standard office visit charges.
| Short Descr | MED SERV EVE/WKEND/HOLIDAY | Medium Descr | SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS | Long Descr | Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service | Status Code | Bundled Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x) | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | Y1 - Other - Medicare fee schedule | MUE | 0 | CCS Clinical Classification | 231 - Other therapeutic procedures |
| 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | FQ | The service was furnished using audio-only communication technology | AJ | Clinical social worker | GZ | Item or service expected to be denied as not reasonable and necessary | CS | Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GA | Waiver of liability statement issued as required by payer policy, individual case | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | SA | Nurse practitioner rendering service in collaboration with a physician | AF | Specialty physician | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system : synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | AH | Clinical psychologist | GC | This service has been performed in part by a resident under the direction of a teaching physician | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AV | Item furnished in conjunction with a prosthetic device, prosthetic or orthotic | CR | Catastrophe/disaster related | F4 | Left hand, fifth digit | F5 | Right hand, thumb | GO | Services delivered under an outpatient occupational therapy plan of care | GP | Services delivered under an outpatient physical therapy plan of care | GQ | Via asynchronous telecommunications system | GT | Via interactive audio and video telecommunication systems | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | HO | Masters degree level | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | QW | Clia waived test | RT | Right side (used to identify procedures performed on the right side of the body) | TV | Special payment rates, holidays/weekends | U4 | Medicaid level of care 4, as defined by each state | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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