2025 CPT code 99060
(Active) Effective Date: N/A Medicine - Special Services, Procedures and Reports Feed
Emergency services provided outside of the office, disrupting other scheduled services, in addition to the basic service.
Modifier 51 is not applicable.
Medical necessity requires that the patient's condition presents an immediate threat to their health and requires immediate attention, preventing the patient from being seen during normal office hours or waiting for an available appointment. Documentation must support the urgency and need for immediate intervention.
The provider is responsible for assessing and managing the patient's emergent condition outside of the office setting, prioritizing them over other scheduled patients.Clear documentation of the emergency and the disruption caused is crucial for proper billing.
In simple words: This code covers the extra effort and disruption when a doctor has to treat a patient with an urgent medical problem outside their office, during regular office hours, causing delays for other scheduled patients. It's billed on top of the usual charges for the medical care itself.
The physician or other qualified healthcare professional provides emergency services to a patient outside of their regular office setting during normal office hours.This service is unscheduled, disrupts other pre-arranged office appointments, and is provided in addition to the basic service rendered. The patient is seen ahead of other scheduled patients due to the emergent nature of their condition.
Example 1: A physician is called to the emergency department to see a patient experiencing severe chest pain during their regular office hours, causing their other scheduled appointments to be delayed., A pediatrician is called to a local urgent care clinic to treat one of their established patients with a high fever and suspected meningitis, requiring them to leave their office and reschedule appointments., A family physician receives a call about a patient involved in a motor vehicle accident and is asked to meet them at a nearby imaging center to assess injuries, causing the physician to disrupt their office schedule.
Documentation should clearly state the nature of the emergency, the time the provider was contacted, the location of the service, and evidence of the disruption to the provider’s regular office schedule (e.g., rescheduled appointments). The medical record should also justify the medical necessity of the unscheduled visit and why the patient could not be seen during regular office hours.
- Revenue Code: Y1 - OTHER - MEDICARE FEE SCHEDULE
- Specialties:Many specialties can utilize this code when providing emergent services outside their office, including but not limited to: Family Medicine, Internal Medicine, Pediatrics, Cardiology, and various surgical specialties.
- Place of Service:Emergency Room - Hospital, On Campus-Outpatient Hospital, Off Campus-Outpatient Hospital, Urgent Care Facility, and other places of service depending on the scenario.