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The CPT® Code 99056 refers to services that are typically rendered in an office setting but are provided outside of the office at the request of the patient. This code is applicable when a physician or another qualified healthcare professional delivers care in a location that is not the usual office environment. The services rendered under this code are in addition to the basic service that the patient would normally receive during an office visit. This situation may arise when a patient requires medical attention in a different setting, such as at home, in a hospital, or another facility, and the healthcare provider accommodates this request. The use of this code highlights the flexibility of healthcare services and the importance of patient-centered care, ensuring that patients can receive necessary medical attention in a manner that suits their needs.
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The use of CPT® Code 99056 is indicated in situations where a patient requests medical services that are typically provided in an office setting but need to be delivered in an alternative location. This may include circumstances where the patient is unable to visit the office due to health issues, mobility limitations, or other personal reasons. The following are specific indications for the use of this code:
The procedure associated with CPT® Code 99056 involves several key steps that ensure the delivery of medical services outside the traditional office environment. Each step is crucial for maintaining the quality of care while accommodating the patient's request for an alternative location. The procedural steps include:
After the services have been provided under CPT® Code 99056, the healthcare provider may offer specific post-procedure care instructions to the patient. This may include guidance on follow-up appointments, any necessary home care, or additional treatments that may be required. The provider should also ensure that the patient understands the importance of continuing their care plan and adhering to any prescribed medications or therapies. Additionally, the provider may need to coordinate with other healthcare professionals involved in the patient's care to ensure continuity and comprehensive management of the patient's health needs.
| Short Descr | MED SERVICE OUT OF OFFICE | Medium Descr | SVC TYPICAL PRV OFFICE PRV OUT OFFICE REQUEST PT | Long Descr | Service(s) typically provided in the office, provided out of the office at request of patient, 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 | 227 - Other diagnostic procedures (interview, evaluation, consultation) |
| 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 | GP | Services delivered under an outpatient physical therapy plan of care | 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. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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. | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider |
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| 2006-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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