SoonerCare Choice After-Hours

Approved Codes

  • 99050 - Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays, Saturdays or Sundays), in addition to basic service.
  • 99051 - Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.

Billing

  • PCPs providing after-hours care should bill the usual E&M code and CPT Code 99050 ($17.80) or 99051 ($6.43).
  • No modifier is required with 99050 or 99051.
  • After-hours codes 99050 and 99051 will pay with CPT codes 99201-99205 and 99211-99215.
  • After-hours codes 99050 and 99051 will pay in addition to the preventive medicine codes 99381-99385 and 99391-99395.

Important Note:

Billing for SoonerCare Choice Members who access care after hours. 

OHCA defines after hours as hours outside your normal established clinic hours of operation, including weekends and holidays. During normal office hours, members  calling for an appointment that are aligned with another PCP should be directed to that member's PCP of record.

Any PCP may provide services to members during their afterhours times of availability.

Child Health checkups (EPSDT exams) may be provided by any SoonerCare Choice provider regardless of time of day service is rendered; however, it is especially important for PCPs to note that credit toward any SoonerExcel payments will only be given for members enrolled with you on the date of service.

If members would like to change PCPs, they should call the SoonerCare Helpline at 1-800- 987-7767.

OHCA can make PCP changes effective on the date of request.