We’ve all seen therapy clients in the evenings or on weekends, either in an urgent situation or as part of our regularly scheduled hours.

But have you ever wondered if you could get paid more for seeing clients outside of normal business hours? Even if it isn’t an emergency, there may be some options.

What CPT codes could you use? Let’s take a closer look at two possible CPT codes that might apply in these situations:

• CPT 99050: Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays, Saturday or Sunday), in addition to basic service
• CPT 99051: Services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service

But what does “regular” office hours mean? I know, therapists have wonky schedules that may vary each day. But let’s say you regularly work from 10 am to 6 pm on Tuesday nights. If you do a 5 pm session that evening, you could bill 99051, since it is an evening slot, but it is within your regularly scheduled office hours. But if you see a client at 7 pm later that night, you might be able to bill 99050, since it’s outside your regularly scheduled hours. Keep in mind that a session that starts during your normal business hours and ends after hours does not typically qualify for these codes.

Tip: It’s a good idea to post your regular office hours on your website, waiting room, signs, and marketing materials. This type of documentation can be used to defend your use of this code to an insurance plan.

How do you bill for these codes? You’ll see these code definitions include the phrase “in addition to basic service.” Both 99050 and 99051 are “add-on” codes, which means you can’t bill them alone. You would bill them separately from – but along with – the CPT code for the session itself (ex. 90834, 90837). So, for the session, you would have two charges on separate lines: One line for the session itself (e.g. 90834, 90837 CPT code), and one on the same date for the add-on code. Both charges would have the same Place of Service codes and modifier, if applicable. You can decide what to charge for the add-on code. If it is reimbursed, it will be based on your contract or what that insurance plan believes is fair.

Will insurance cover it? This is the key question, isn’t it? Always keep in mind the old saying, “just because there is a CPT code for something does not mean insurance will pay for it.”

• Medicare: At the time of this writing it appears that 99050 and 99051 are not covered by Medicare. They are considered “bundled” in the price of the primary code, so no extra charge is permitted. “I would NEVER recommend people try to bill this with Medicare, says Medicare expert Susan Frager of PsychBillingCoach.com. “It’s never been on any list of Medicare allowable codes that I’ve seen. If it’s not an emergency, they’d argue that agreeing to see someone outside of regular business hours is your choice, but not something you’d be allowed to charge the client for.”
• Medicaid: Since Medicaid is a state-run program, their coverage policies vary depending on the state, so you’d need to check your state and local policies.
• Private (aka “commercial”) health plans: Coverage may vary, even among different clients who have the same insurance company. If the health plan does cover it, they may have certain rules, such as only covering specific clinicians (ex. doctors), network providers only, or not allowing for intake appointments. For example, I was able to find that United Healthcare does cover these codes in certain circumstances, however they did not appear to allow it for psychotherapists, and seem to only cover in-person sessions. See their coverage details here.  Another example is Anthem Blue Cross Blue Shield of New York’s policy, see their coverage details here.

In addition, insurance plans may even have different definitions about what they consider evenings, holidays, or “after hours.” Usually “holidays” generally apply to federal holidays, and “after-hours” is defined as between 5 pm and 8 am on weekdays, but I’ve seen plans with a 6 pm start time. As always, don’t assume.

Also, the plan may not reimburse unless these codes are in your contract. Codes beginning with 99- often aren’t covered for Masters/PhD-level clinicians since they belong to the “Evaluation and Management” code set, which are typically restricted to medical providers. Your contract likely came with a fee schedule – a list of CPT codes for which you would be reimbursed. If these two codes are not on your contract (and they often aren’t), you could try to negotiate with the health plan to add them.

So, in summary, before you bill the plan, what should you check?

• If either (or both) of these codes are covered
• If they can be used for intake sessions
• If your license is covered for these codes
• If the session must be in-person
• What hours are considered evenings, holidays, or after-hours
• If codes are only covered for network providers
• If these codes are in your plan contract
• Ask for written documentation of these policies before billing

Is there any special documentation required? As with all session notes, be sure you have the ACTUAL THERAPY start and stop times recorded in the note (not just the length of the session or scheduled session start and stop time), so it can easily be determined that this was an after-hours session. It may be wise to document in your notes that it was an evening, after-hours, or weekend session, and why there was a particular need for the after-hours session.

In an insurance audit, defend the rationale for the additional fee by showing them how this leads to savings to the health plan. Explain that if your practice did not offer these after-hours services, clients might instead use urgent care centers or Emergency Rooms, which would increase the plan’s costs.

Can you charge clients who have private insurance extra for after-hours or evening slots if the plan won’t cover them? This may be possible if clients are informed in writing and in advance about these additional costs. You may want to do this only after checking the terms of your contract, contacting the plan about coverage, and/or getting a clear denial from the health plan. But even if you get a denial, you may not be able to charge the client. For example, Horizon Blue Cross / Blue Shield of New Jersey’s policy states, “in denied instances where the provider is [a] participating [provider], there shall be no member liability.” See full policy here.

If you do charge a client with private insurance, have them sign a Self-Pay Agreement, outlining that they understand that this charge is not covered by their insurance, stating what the fee will be, and accepting the additional charge. (A sample Self-Pay Agreement is available in my Practice Forms Packet – click here).

My take? These codes appear to be designed to allow clinics and primary care medical providers to reimburse staff for coming to the clinic or office outside of normal business hours. I would be cautious about using these codes to bill health plans or clients for psychotherapy – especially if using them routinely – unless I had written clarification about the health plan’s coverage policies.

I’d love to hear your thoughts and experiences getting paid (or denied) for these codes. Please write to me and tell me your license, and what health plan has paid or denied you for them.