Policy updates on observation stay and after-hours-weekend care


Here are policy updates on observation stay and after-hours, weekend care.

  • Reimbursement policy: Observation stay
    Under this new policy, to go into effect Aug. 1, 2019, we will no longer reimburse observation stays that are less than eight (8) hours or more than 48 hours. This policy follows guidance from the Centers for Medicare & Medicaid Services. It will apply to our commercial and Medicare Advantage plans.
  • Payment policy: After-hours and weekend care
    We have updated this policy to note we will only reimburse after-hours care under CPT codes 99050 and 99058 to participating primary care providers (PCPs) when the care is provided in a non-facility based, in-office setting, POS 11 (place of service) designation. This policy goes into effect Sept. 1, 2019 and will only apply to commercial plans.