After-Hours Service

Priority Health reimburses for CPT code 99053 when:

• The rendering provider was called to the 24-hour facility to render unscheduled services
• Documentation within the medical record indicates the special circumstances of the visit

Example:

1. A member refuses treatment from an ER physician and requests that his/her PCP comes to the facility to treat the illness/injury.
2. The PCP comes onsite after hours to treat the member.
3. The PCP or staff documents the special circumstances of the visit within the medical record.
4. The PCP reports CPT 99053 in addition to the basic service.

99053 is incidental to any Evaluation and Management service(s), surgical service(s), laboratory service(s), etc., when provided by emergency room physicians, anesthesiologists, radiologists, laboratory staff or any other provider scheduled to be onsite at the time the service was rendered.