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Expanded Incentive for After-Hours Availability

Date: 03/26/26

Expanding access to timely care is a shared priority for Sunshine Health and our provider partners. To support this effort, effective May 1, 2026, Sunshine Health is pleased to expand our incentive for providers who provide care for members after hours. This initiative encourages greater availability beyond standard office hours, helping ensure members can access care when they need it most.

What is Considered After Hours?

  • Healthcare services rendered from 5 p.m. to 8 a.m. local time
  • All weekends
  • All federally recognized holidays
  • After-hours telehealth services are included

Which Providers are Eligible?

  • Medical Doctors (MDs)
  • Doctor of Osteopathic Medicine (DOs)
  • Physician Assistants (PAs)
  • Psychologists (PhDs)
  • Nurse Practitioners (NPs)
  • Therapists (Physical, Speech and Occupational Therapy/PT, ST, OT only)
    • Therapy Assistants included

How Much is the Incentive?

As part of the expansion of our After Hours Incentive, we have increased the incentive amount for most providers:

  • $40 per member per appointment for MDs, DOs, PAs, PhDs, and NPs
  • $15 per member per appointment for PT, ST and OT therapists and therapy assistants

This Guidance Applies to These Products

  • Sunshine Health Medicaid (MMA)
  • Comprehensive Long Term Care (LTC)
  • Sunshine Health Pathway to Shine Child Welfare Specialty Plan (CWSP)
  • Sunshine Health Mindful Pathways Serious Mental Illness Specialty Plan (SMI)
  • Sunshine Health Power to Thrive HIV/AIDS Specialty Plan (HIV)
  • Children’s Medical Services (CMS) Health Plan

How to Indicate After-Hours Services?

Providers must use one of these procedure codes in addition to an Evaluation and Management (E/M) service code for services scheduled outside regularly scheduled hours:

  • 99050: After-hours care provided in provider’s office outside of regular office hours.
  • 99051: After-hours care provided during regularly scheduled evening, weekend or holiday office hours.
  • 99060: After-hours emergency care.

Note: Modifiers are not needed when reporting after-hours services.

How is Sunshine Health Capturing this Information?

Sunshine Health will utilize claims data to verify when after-hours services were rendered, which indicates they occurred outside of regularly scheduled hours.

Please remember to indicate both the E&M code and after-hours code.

Corrected Claims

Providers who need to rebill with a corrected claim, please ensure to include both the E&M code and after-hours code.

Standards for Appointment Scheduling

Find the appointment standards for each health plan:

After-Hours Incentive Tips

  • Visits that start during regular office hours but end after hours are not eligible for the incentive.
  • Please ensure that your practice informs members about regular office hours and after-hours availability.
  • Your website should be updated with your most current office hours and after-hours availability.

Questions?

Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:

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