After-hours time premium maximums

Did you know that the after-hours time premium (03.01AA – payable for time spent after hours in active treatment hospitals, nursing homes, or auxiliary hospitals, AACC, UCC) has maximums?

Many physicians are unaware that there are maximums for this health service code (HSC). The maximums allowable per day, per time period for the total time spent are as follows:

  • 20 units – TEV (Monday-Friday 1700-2200)
  • 8 units – TNTP (Any day 2200-midnight)
  • 28 units – TNTA (Any day midnight-0700))
  • 60 units – TWK (Weekend 0700-2200)
  • 60 units – TST (Statutory holidays 0700-2200)
  • 60 units – TDES (Designated holidays 0700-2200)

This means that if the total time spent managing patient care for 15 patients required three hours of time, you could submit 12 units of 03.01AA. You may ONLY submit claims for 03.01AA for the total time spent managing patient care and NOT the total number of patients that were seen. You must have physically seen the patient on the same date in order to submit claims for 03.01AA.

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  • This code may only be claimed for physician services provided to patients in active treatment hospitals, nursing homes or auxiliary hospitals AACC, UCC in the after hours. ("After hours" is defined as 5 p.m. to 7 a.m. on weekdays and any time on weekends or statutory or designated holidays.)
  • Patient must have been seen on the same date of service.
  • Activities that are included in claiming for time:
    • Charting.
    • Reviewing (but not waiting for lab or DI results).
    • Consulting with other health providers on the service about the patient’s care.
    • Writing a referral/consultant letter.
    • Any other physician activities included in managing the patient’s care.
  • Bill at the start of the encounter or during the time period where the bulk of the time was spent (e.g., if the encounter starts at 2155 and ends at 2210, claim 03.01AA TNTP01).
  • If the time spent managing patient care crosses over two time periods, more than one modifier can be used (e.g., if the encounter starts at 2100 and ends at 2345, claim 03.01AA TEV04 TNTP07).
  • If the time spent managing patient care crosses two dates of service, separate the claim into two claims with two dates of service.
  • For example, if the encounter starts on day one at 2100 and ends on day two at 0045, the claim would look like this:
    • Claim one for day one, 03.01AA TEV04 TNTP08.
    • Claim two for day two, 03.01AA TNTA03.

These fee codes may not be claimed for the following:

  • Stand-by time.
  • Completing discharge summaries or clinical notations after the patient has been discharged unless the patient was seen on the same day.
  • More than four units per hour per physician may not be claimed (the time claimed cannot exceed actual time spent managing patient care).
  • Providing uninsured services.
  • Non-physician time.

Additional information:

  • This HSC is claimed on a time basis and pays strictly for the time spent managing the patient’s care in relation to an insured service.
  • 03.01AA is claimed in 15-minute units.
  • Only the time that the physician actually spent managing patient care is billable.
  • 03.01AA is billable in addition to other services at the same encounter on the same date of service for after-hours work.
  • Modifiers that apply to 03.01AA are as follows:
  • TEV (weekdays 1700-2200). Maximum of 20 units.
    • TNTP (2200-2400). Maximum of 8 units.
    • TNTA (2400-0700). Maximum of 28 units.
    • TWK (weekends 0700-2200). Maximum of 60 units.
    • TST (0700-2200 statutory holidays). Maximum of 60 units.
    • TDES (designated statutory holidays 0700-2200). Maximum of 60 units.

A claim for 03.01AA must include a modifier that signals the time of day and the length of time it took to provide the service. For example, if the service started at 2015 hours and took 45 minutes, the claim for 03.01AA would look like this: HSC 03.01AA modifier TEV03.

  • The “TEV” portion of the modifier signals that the service was provided in the evening.
  • The “03” portion of the modifier signals that the service took approximately 45 minutes.

Some examples

Billing scenario 1

On a Monday night at 2230, an internist gets a call from the nurse on the ward requesting that s/he come on a priority basis to the hospital to assess a patient’s condition. The total time spent managing the patient's care is 38 minutes. The claim would look like this:

  • 03.05P in-patient callback (2200-2400).
  • 03.03DF hospital visit in association with a callback.
  • 03.01AA (Modifier) TNTP03.

Billing scenario 2

On a Saturday at 0200, a GP gets a call from the hospital to see a patient in the non-rotation duty (GR 1.13) emergency department on a priority basis. Due to the nature of the illness/injury, the physician takes a full history and performs a complete physical (appropriate to their specialty), the service lasts for 50 minutes. The claim would look like this:

  • 03.03MD Callback (2400-0700).
  • 03.04A (Modifier) CMXC30.
  • 03.01AA (Modifier) TNTA04.

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