How To Use CPT Code 99026

CPT 99026 describes the provision of hospital mandated on-call services by a healthcare provider for a period of one hour. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 99026?

CPT 99026 can be used to report the provision of hospital mandated on-call services by a healthcare provider. This code is used when the provider makes themselves available to perform services in the hospital on an on-call basis for a period of one hour, as part of an agreement with the facility.

2. Official Description

The official description of CPT code 99026 is: ‘Hospital mandated on-call service; in-hospital, each hour.’

3. Procedure

1. The healthcare provider agrees to be available for on-call services in the hospital.
2. During the on-call period, the provider remains in the hospital and is ready to provide services if called upon.
3. The on-call period lasts for one hour.
4. The provider may be required to perform various services or procedures during the on-call period, depending on the needs of the hospital.
5. The provider does not need to have face-to-face contact with patients during the on-call period, but they must be available if their services are required.

4. Qualifying circumstances

CPT 99026 is used when a healthcare provider fulfills their obligation to be available for on-call services in the hospital for a period of one hour. This code is applicable when the provider is on-call as part of an agreement with the facility and is ready to provide services if called upon. It is important to note that on-call services are distinct from standby services, where the provider is in attendance for a treatment procedure but does not provide face-to-face contact with the patient.

5. When to use CPT code 99026

CPT code 99026 should be used when a healthcare provider fulfills their obligation to be available for on-call services in the hospital for a period of one hour. This code should not be reported for time spent performing procedures or services that are reported separately. It is important to review the guidelines of individual payers regarding coverage for on-call services.

6. Documentation requirements

To support a claim for CPT 99026, the healthcare provider must document the following information:

• Agreement with the facility for on-call services
• Date and duration of the on-call period
• Any services or procedures performed during the on-call period
• Signature of the healthcare provider

7. Billing guidelines

When billing for CPT 99026, ensure that the healthcare provider fulfills their obligation to be available for on-call services in the hospital for a period of one hour. This code should not be reported for time spent performing procedures or services that are reported separately. It is important to review the guidelines of individual payers regarding coverage for on-call services.

8. Historical information

CPT 99026 was added to the Current Procedural Terminology system on January 1, 2003. There have been no updates to the code since its addition.

9. Examples

1. A physician fulfilling their obligation to be available for on-call services in the hospital for one hour.
2. A surgeon remaining in the hospital and ready to perform emergency procedures during their on-call period.
3. A radiologist being on-call to interpret imaging studies and provide consultations as needed.
4. An anesthesiologist being available to administer anesthesia during emergency surgeries.
5. A cardiologist being on-call to provide immediate care for patients experiencing cardiac emergencies.
6. A pediatrician being available to provide consultations and care for pediatric patients in the hospital.
7. An obstetrician being on-call to attend to laboring patients and perform emergency deliveries.
8. A psychiatrist being available to provide consultations and assessments for patients in the psychiatric unit.
9. An intensivist being on-call to manage critically ill patients in the intensive care unit.
10. An emergency medicine physician being available to provide immediate care for patients in the emergency department.