2025 CPT code 99027
(Active) Effective Date: N/A Medicine - Special Services, Procedures and Reports Feed
Hospital mandated on-call service, out-of-hospital, each hour.
Modifiers may be applicable. Modifier 52 may be used if the service is less than a full hour. Check payer guidelines and be prepared to submit appropriate documentation to support the use of any modifier.
Medical necessity for this code hinges on a pre-existing agreement between the provider and the hospital mandating the provider's availability during specific times outside normal working hours.The on-call service must be necessary for the potential provision of patient care and mandated by the facility. This differs from voluntary on-call arrangements.
The provider is available to perform services if called upon by the hospital, from a location outside the hospital, for a duration of one hour per unit of this code billed. The on-call period is mandated by the hospital as part of an agreement.
In simple words: This code covers the time a healthcare provider spends being on-call, outside of the hospital, as required by the hospital, for each hour.This is for when they are available to be called in but are not actively seeing patients. If they are required to be present at the hospital but not actively involved in patient care, a different code (99360) may apply. Any time spent performing other billable procedures or services should not be counted in this on-call time.
Hospital mandated on-call service; out-of-hospital, each hour. Notes: (For standby services requiring prolonged attendance, use 99360, as appropriate. Time spent performing separately reportable procedure(s) or service(s) should not be included in the time reported as mandated on-call service)
Example 1: A surgeon is on call from home for emergency surgeries, as required by the hospital. They are on call for 2 hours but do not receive a call. The surgeon would bill two units of 99027., An anesthesiologist is required by the hospital to be available by phone for consultations related to pain management outside of regular hours. They are on-call for 1 hour and receive a brief consultation call.The consultation itself may be billed separately, but the anesthesiologist can bill one unit of 99027 for the hour of mandated on-call availability., A hospital requires a cardiologist to be on call for emergencies while the cardiologist is out of town but within reasonable distance to respond. The cardiologist is on call for 3 hours and has to go to the hospital to perform an emergency procedure. The time spent performing the emergency procedure is billed separately. The 3 hours spent on call prior to the procedure being performed are billed as 3 units of 99027.
Documentation should clearly indicate the period of mandated on-call time, the location where the provider was on call (out-of-hospital), and the agreement with the hospital requiring the on-call service. The documentation should differentiate between time spent on call and time spent providing other billable services.
** Medicare typically does not cover standby or on-call services; however, other payers may reimburse. Verify coverage with individual payers.
- Revenue Code: M3 (EMERGENCY ROOM VISIT)
- Specialties:This code is not limited to specific medical specialties. It applies to physician or other qualified healthcare professional providing on call services.
- Place of Service:Off Campus-Outpatient Hospital