Ask Dr. Stern: CPT Codes 99381-99394 for Urgent Care?

Q: Can CPT codes 99381-99394 be used for urgent care? If not when are they applicable?

A: Generally, the business of urgent care does not involve these comprehensive medicine evaluations and management services. If an urgent care center decides to perform such services, it is generally legal to do so.

Unless an urgent care center is forbidden by state statute (of which I am not aware of any such laws) or managed care contract from performing comprehensive medicine evaluations and management or from performing routing primary care medicine, then the urgent care center may perform these services.

NOTE: When an urgent care center performs primary care services to patients, it is important for both provider and patient to be clear on what obligations for follow-up, on-call services, and hospital admissions are to be provided. Providers should seek legal advice as to their obligations under federal and state statutes and rules.