6 codes
The CPT family
- 99050, 99051, 99053, 99056, 99058 and 99060, all treated by CMS as bundled [1]
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Urgent care after-hours codes 99050, 99051 and 99058: the POS 20 rulebook
Medicare bundles every after-hours code, UnitedHealthcare pays two of them only to primary care at places of service that exclude POS 20, and Cigna pays two with a claim-content condition. This rulebook turns those policies into a payer table, a claim build and a contract clause.
The rule in one breath: Medicare never pays 99050 to 99060 separately; UnitedHealthcare pays 99050 and 99051 only to participating primary care at eight places of service that do not include POS 20; Cigna pays 99050 and 99058 when they ride with a payable office E/M on a claim that carries nothing else. Everything beyond that is contract language [1] [2] [3].
99050 · outside posted hours
99051 · scheduled evening, weekend
99058 · emergency, disrupts schedule
POS 20 · Urgent Care Facility
Edition
2027 rulebook
Focus
After-hours codes
Codes
99050 · 99051 · 99058
Payers
Medicare · UHC · Cigna
Audience
Urgent care owners
Length
14 min read
StatusB
CMS bundles 99050 to 99060; no RVUs and no separate payment [3]
8POS, not 20
UnitedHealthcare pays 99050 and 99051 at eight places of service; urgent care is not one [1]
9905099058
Paid by Cigna with a listed office E/M when nothing else is on the claim [2]
Jun 42026
Cigna re-added its after-hours language for 99051 to 99056 and 99060 [2]
The after-hours codes look like free money. They are not.
Urgent care lives in the hours primary care does not keep. CMS considers 99050, 99051, 99053, 99056, 99058 and 99060 bundled into the payment for other services the same day [1], and the national policies that pay a few of them attach conditions on specialty, place of service and claim content.
What each code claims, and who pays it
Descriptors paraphrased in plain words; the payer columns come from the policies cited [1] [2] [3].
| Code | Plain-English meaning | Medicare | UnitedHealthcare commercial | Cigna commercial |
|---|---|---|---|---|
| 99050 | Service in the office outside regularly scheduled hours, or on days normally closed | Bundled, status B | Paid to listed primary care at listed POS, in addition to basic services | Paid with 99202 to 99205, 99212 to 99215 or 99417 when the claim carries only those codes |
| 99051 | Service during regularly scheduled evening, weekend or holiday hours | Bundled, status B | Paid to listed primary care at listed POS, with acute care services, not preventive | Not reimbursed, status B |
| 99053 | Service between 10 pm and 8 am at a 24-hour facility | Bundled, status B | Not reimbursed | Not reimbursed, status B |
| 99056 | Office service provided out of the office at the patient's request | Bundled, status B | Not reimbursed | Not reimbursed, status B |
| 99058 | Office service on an emergency basis that disrupts other scheduled services | Bundled, status B | Not reimbursed | Paid with the listed E/M codes, same claim-content limit |
| 99060 | Emergency service out of the office that disrupts other scheduled services | Bundled, status B | Not reimbursed | Not reimbursed, status B |
Six codes in, at most two out
After-hours codes each payer pays separately, out of six, at an urgent care (POS 20)
Policy positions only [1] [2] [3]; a contract clause can change any row.
Medicare fee-for-servicestatus B on all six
0 of 60%
UnitedHealthcare, any POSprimary care only
2 of 633%: 99050, 99051
UnitedHealthcare at POS 20not a listed POS
0 of 60%
Cigna, with listed E/M onlyclaim-content condition
2 of 633%: 99050, 99058
Other commercial, Medicaid MCOpolicy silent
0 to 6the contract decides
0246 codes
Published policyPayable with conditions, or by contract
Which code the clock points to, before the payer rule applies
- 1Before posted opening99050 zone
- 2Regular posted hoursNo after-hours code
- 3Scheduled evening hours99051 zone; Sunday with posted Sunday hours is also 99051
- 4After posted close99050 zone; Sunday or holiday with the site normally closed is 99050
- 5Walk-in emergencyDisrupts the schedule: 99058, at any hour
Set by posted hoursSet by disruptionWhether any of these pay is decided by the payer table, not by the clock
Status B, and why a modifier changes nothing
Status B: payment for covered services always bundled into payment for other services; no RVUs or payment amounts, no separate payment is ever made, and payment is subsumed by the service the code is incident to [3]. Leave the line off the Medicare claim: it will not pay, it adds a denied line to first-pass yield, and it invites a review of the E/M it rides on.
No RVUs
Status B codes carry no relative value units on the fee schedule [3].
No separate payment
Payment is subsumed by the service the code is incident to [3].
No override
Cigna, aligning with CMS: a modifier will not over-ride the edit [2].
Medicare Advantage
Plans write their own payment rules; read the contract rather than assuming they mirror CMS or their commercial product. For comparison, S9083 and S9088 carry status I [3] [5].
A specialty and place of service test
Policy 2026R0044A: although CMS bundles 99050 and 99051, UnitedHealthcare provides additional compensation to participating primary care providers for seeing patients who would otherwise need more costly urgent care or emergency room settings [1]. The policy exists to keep patients out of urgent care, so it is built to exclude urgent care. It applies to all Commercial and Individual Exchange plans.
| Test | What passes | What an urgent care usually has |
|---|---|---|
| Place of service | School (03), IHS free-standing (05), Tribal 638 free-standing (07), Office (11), Independent Clinic (49), FQHC (50), State or local public health clinic (71), RHC (72) | POS 20, Urgent Care Facility, which is not listed |
| Rendering specialty | Adolescent medicine and pediatrics, family practice, general practice, geriatric medicine, internal medicine, OB/GYN, nurse practitioners, certified nurse midwives, physician assistants | Often family practice, emergency medicine or NP/PA staff |
| 99050 timing | Outside regularly scheduled hours, or days normally closed, with a basic service | Posted hours usually cover evenings and weekends |
| 99051 timing | During scheduled evening, weekend or holiday hours, with acute care services, not preventive | Most urgent care hours sit here, but the POS test fails first |
Do not solve the POS test by changing the POSCMS defines POS 20 as a location distinct from an office whose purpose is unscheduled, ambulatory care for patients seeking immediate attention [4]. Reporting POS 11 from a freestanding urgent care to pass a payer test misstates where the service happened. The clean route is a contract clause, below.
Two codes and a claim-content condition
Policy R24 aligns with CMS on 99051 to 99056 and 99060 (status B, not reimbursed) and departs on two: 99050 and 99058 are reimbursed with a payable E/M from 99202 to 99205, 99212 to 99215 or 99417, on claims where only those codes and the E/M are billed; adding other codes may alter the payment [2]. The after-hours language was added back on June 4, 2026, so mid-2026 remittances may differ from a year earlier.
| Claim element | Rule | Urgent care consequence |
|---|---|---|
| E/M line | 99202 to 99205, 99212 to 99215 or 99417, and payable | A denied or bundled E/M takes the after-hours code with it |
| After-hours line | 99050 or 99058 only | 99051, the evening-hours code most urgent cares would use, is not paid |
| Other lines | Adding other codes may alter the after-hours payment | A laceration repair or X-ray on the same claim can change the result; test it on your remittances |
| S9083 or S9088 | Not reimbursed | No global claim to Cigna; the after-hours code cannot ride on S9083 anyway |
Two questions, then the contract
PayerDoes it separately pay any after-hours code?Is POS 20 on the list?
UnitedHealthcare2026R0044A
Pays?99050 and 99051 for primary care at 8 POS codes [1]
POS 20?No. Leave the line off, or contract for it
Everyone elsePolicy silent
Pays?The contract decides
ActionGet the clause in writing or leave the code off the claim
Three ways to contract for extended hours at POS 20
Where the published policy excludes POS 20, the contract is the only durable route to after-hours revenue. Write the clause so a claims examiner can apply it without calling the contract manager.
| Structure | Clause language to ask for | Claim build | Watch for |
|---|---|---|---|
| Named code carve-out | The plan pays 99051 (or 99050) at POS 20 when reported with an acute office E/M, at a stated allowed amount, notwithstanding the plan's after-hours reimbursement policy | E/M plus 99051, POS 20 | Policy-override language; without it the system edit wins |
| Setting add-on | The plan pays S9088 in addition to the E/M at POS 20 | E/M plus S9088 | UnitedHealthcare treats S9088 as informational and Cigna does not pay it [2] [5]; the clause must name the payment |
| POS 20 rate uplift | Services at POS 20 are paid at a stated percentage of the fee schedule, replacing after-hours codes | E/M and procedures only, POS 20 | Simplest to administer; confirm it applies to all hours, not only extended hours |
Four steps to a clause that overrides the edit
- 1Attach the policiesPull the plan's after-hours and urgent care reimbursement policies into the negotiation file, so the clause overrides a named policy
- 2Ask for the override sentenceThe clause applies notwithstanding the plan's reimbursement policy on after-hours codes
- 3Name everythingThe codes, the POS, the pairing (acute E/M, not preventive) and the allowed amount or percentage
- 4Date and testEffective the first of a month; test the first ten claims against the remittance before scaling
Document the clock
99050 and 99051 are defined against the practice's regularly scheduled hours [1]. If posted hours already run 8 am to 8 pm seven days a week, a 7 pm visit is inside posted hours: 99050 does not apply, 99051 may, where a payer pays it.
Dated posted hours
Per site, including holiday schedules, so an auditor can tie each after-hours line to the schedule in force that day.
Arrival and service time
Captured in the record; the claim does not carry it, the appeal will need it.
Acute vs preventive
Separated at charge entry: UnitedHealthcare pays 99051 with acute care services, not preventive medicine codes.
Never 99053 at a 24-hour site
Unless a contract names it; CMS bundles it and both national policies deny it.
When to add the line, by payer
| Payer | Add 99050? | Add 99051? | Add 99058? | Notes |
|---|---|---|---|---|
| Medicare fee-for-service | No | No | No | Status B; bundled [3] |
| Medicare Advantage | Contract | Contract | Contract | Plans write their own rules; load each contract |
| UnitedHealthcare commercial at POS 20 | No | No | No | POS 20 is not a listed place of service [1] |
| Cigna commercial | Yes, with listed E/M, nothing else on the claim | No | Yes, with listed E/M, nothing else on the claim | Other codes may alter payment [2] |
| Other commercial and Medicaid MCOs | Contract | Contract | Contract | Silent policy means the contract decides; get it in writing |
Load the answer as a payer attribute so the scrubber adds or strips the line automatically. The same table drives the S9083 decision: see the contract billing map; the 2027 operating manual places after-hours codes as control five of twelve.
Count, do not estimate
The data is already in your practice management system: visits by hour, by payer, by E/M code. The output is a visit count per payer per code that a clause would convert to revenue, and a count of lines you are sending to payers that bundle them.
- 1ExportTwelve months of visits with arrival time, payer, POS and E/M code
- 2Tag the zoneAgainst posted hours in force that day: inside hours, scheduled extended hours (99051 zone), outside posted hours or closed day (99050 zone)
- 3Join to the payer tableCount 99051-zone visits with payers that would pay under a carve-out, and 99050-zone and 99058 visits with Cigna
- 4Count the reworkAfter-hours lines sent in the last year to Medicare and UnitedHealthcare: stop this week
Takeaway
The negotiation number is visits in the 99051 zone by payer. The hygiene number is after-hours lines sent to payers that bundle them. Both come from the same export.
Five moves, and where we fit
Strip after-hours lines from Medicare and UnitedHealthcare POS 20 claimsThey bundle; the line only costs first-pass yield.
Build the Cigna two-line claimListed E/M plus 99050 or 99058, nothing else; test on remittances.
Load every contract's after-hours position as a payer attributeOur urgent care billing services team does this, strips the lines that bundle, and builds the visit-by-hour export for the next negotiation.
Run the four-count export before the next renewalVisits in the 99051 zone by payer are the negotiation number.
Work denied after-hours lines by root causeIn Work Genie, our AR workflow platform. The urgent care RCM and urgent care RCM solution pages route to the same team.
Record posted hours per site, datedThe appeal file starts with the schedule in force that day.
Frequently asked questions
Can an urgent care bill 99051 to Medicare?
The line will not be paid. CMS assigns 99050, 99051, 99053, 99056, 99058 and 99060 status B, bundled into the payment for other services the same day, with no RVUs and no separate payment. A modifier does not override the edit. Leave the line off Medicare claims.
Does UnitedHealthcare pay 99050 or 99051 at POS 20?
Not under policy 2026R0044A. UnitedHealthcare pays 99050 and 99051 to participating primary care providers only in eight listed non-facility places of service: 03, 05, 07, 11, 49, 50, 71 and 72. POS 20, Urgent Care Facility, is not listed, and 99053, 99056, 99058 and 99060 are not reimbursed at all. A contract clause can change this for your group.
Which after-hours codes does Cigna pay?
Cigna policy R24 pays 99050 and 99058 when billed with a payable E/M from 99202 to 99205, 99212 to 99215 or 99417, and only on claims that carry just those codes; adding other codes may alter the after-hours payment. Cigna aligns with CMS on 99051 to 99056 and 99060 and does not reimburse them.
Is it acceptable to report POS 11 so an after-hours code pays?
No. CMS defines POS 20 as a location distinct from an office whose purpose is unscheduled, ambulatory care for patients seeking immediate attention. The place of service must describe where the service happened. The compliant route to after-hours revenue at an urgent care is a contract clause that names the code, the POS and the payment.
- UnitedHealthcare Commercial and Individual Exchange Reimbursement Policy 2026R0044A, After Hours and Weekend Care Policy, Professional (anniversary review March 1, 2026)
- Cigna Reimbursement Policy R24, Omnibus Reimbursement Policy, After-Hours Care and Urgent Care Centers sections (last updated June 4, 2026)
- CMS Medicare Claims Processing Manual, Chapter 23, section 30.2.2, MPFSDB Status Indicators (status B and status I definitions)
- CMS Place of Service Code Set (page last modified February 17, 2026)
- UnitedHealthcare Commercial and Individual Exchange Reimbursement Policy 2026R0108A, Urgent Care Policy, Professional (anniversary review August 1, 2026)
- American Medical Association, CPT Evaluation and Management (updated January 26, 2026)
Checked October 25, 2026. Rules change; confirm against the source before relying on them. Figures from the CY2027 Physician Fee Schedule proposed rule are proposed, not final; re-check them against the final rule.
Want your after-hours lines and contracts read for you?
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