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CPT codes for Prolonged services


Prolonged service CPT codes may be billed when a provider spends 30 minutes or more beyond the average time with a patient (face-to-face) for
a given Evaluation & Management service. Prolonged service codes are all add-on codes hence they should not be billed independently. The claim for prolonged services will be eligible for payment only if an E & M code is submitted along with the claim.

CPT codes for Prolonged services

99354 Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; first hour. (To be reported along with CPT codes 90809, 90815, 99201-99215, 99241-99245, 99324-99337 and 99341-99350).

99355 Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; each additional 30 minutes. (To be reported along with CPT code 99354).

99356 Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour. (To be reported along with CPT codes 90822, 90829, 99221-99233, 99251-99255 and 99304-99310).

99357 Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; each additional 30 minutes. (To be reported along with CPT code 99356).

99358 Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); first hour. (To be reported along with CPT codes 99201 - 99215, 99217 - 99239, 99241 - 99255, 99281 - 99285, 99288, 99291, 99304 - 99318, 99324 - 99337, 99339 - 99350, 99363 - 99364, 99366 - 99368, 99374 - 99375, 99377 - 99380, 99397, 99401 - 99409, 99411 - 99412, 99420, 99450, 99455 - 99456, 99460 - 99466, 99468 - 99480).

99359 Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); each additional 30 minutes. (To be reported along with CPT code 99358).

Please note:

Do not report any service less than 30 minutes

Do not report any service that fails to extend into the next time period by 15 minutes or more

Prolonged services will not be considered for separate reimbursement with CPT code 99211

Reference:
https://www.cms.gov/MLNMattersArticles/downloads/MM5972.pdf

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