2025 CPT code 99026
(Active) Effective Date: N/A Revision Date: N/A Medicine - Miscellaneous medical services Medicine Services and Procedures > Special Services, Procedures and Reports Feed
Hospital-mandated on-call service; in-hospital, each hour.
Modifiers may apply depending on the specific circumstances of the on-call service.Consult the CPT manual and payer guidelines for specific modifier guidance.
Medical necessity is established by the hospital's requirement of the provider to be on call, indicating a pre-arranged agreement based on hospital needs, not individual patient needs.Documentation must demonstrate a formal agreement between the provider and hospital.
The provider's clinical responsibility is to be available for medical services at the hospital during the specified on-call period.This includes responding to requests for services, although it does not necessarily involve direct patient interaction.
- Medicine Services and Procedures > Special Services, Procedures and Reports
- 99000-99082 (Special reports and services adjunct to basic services)
In simple words: This code is for doctors who are on call at a hospital and available to work if needed for one hour.It doesn't include time spent actually seeing patients; it's just for being available.
This CPT code reports hospital-mandated on-call services performed in the hospital for each hour.The provider makes themselves available to perform services on an on-call or as-needed basis, fulfilling an agreement with the facility.Time spent performing procedures or services reported separately should not be included in the time reported for mandated on-call service.On-call services are distinct from standby services (where the provider is present but doesn't have direct patient contact).
Example 1: A surgeon is on call at a hospital for one hour in the evening.They are not called for any emergencies or procedures.They bill for one hour of 99026., An anesthesiologist is on call at a hospital from 7 pm to 7 am, with a one-hour break. They bill for 11 hours of 99026., A hospitalist is on call in a medical unit for four hours, then consults with several patients and spends additional time in the hospital. The hospitalist bills for four hours of 99026 and appropriate codes for the consultations.
Documentation should include the start and end times of the on-call period, confirmation of an agreement between the provider and the hospital for on-call services, a record of any interruptions to the on-call period, and clear distinction between on-call time and time spent providing other, separately billable services.The type of hospital and the on-call arrangement must be clearly documented.
** Medicare does not reimburse for standby or on-call services.Third-party payer coverage may vary.
- Revenue Code: M3 (Emergency Room Visit)
- RVU: Information not provided. RVUs vary by payer and location.
- Payment Status: Active (but coverage varies by payer)
- Modifier TC rule: This code does not have a technical component.
- Fee Schedule: Information not provided.Fee schedules vary by payer and location.
- Specialties:Hospital Medicine, Surgery, Anesthesiology, Emergency Medicine
- Place of Service:Inpatient Hospital