99499 CPT Code (2022) | Description, Procedure, Guidelines & Reimbursement

CPT code 99499 may be billed for Evaluation & Management services that are not defined by another CPT code. Below you can find the official description of CPT 99499, the procedure, reimbursement, and billing guidelines. 

1. Description

CPT 99499 is officially described by the CPT manual as follows: “Unlisted evaluation and management service.”

2. Procedure

The 99499 CPT code can be used for E/M services not described by any other evaluation and management CPT codes.

Make sure to consult the health provider who performed the procedure to ensure you have all the necessary documentation for billing an unlisted E/M procedure.

3. Reimbursement

You can bill zero units on the date of service of CPT code 99499. It is possible to use 3 units for documentation to prove the medical necessity of this procedure.

Below are the costs and RUVs for CPT 99499.

	Costs	RUVs
Facility	$0.00	0
Non-Facility	$0.00	0

As you can see, the reimbursement of CPT 99499 is zero because it is an unlisted procedure.

It is possible to get reimbursed for this procedure based on the complexity, but CMS does not specify this; therefore, you need to check the payer’s guidelines.

You can add modifier 95 to CPT code 99499 if you want to report telemedicine services. Report with HCPCS Q3014 for services at the origination site.

4. Billing Guidelines

The CPT manual explains that you can not choose a CPT code if the provided procedure does not match the description of a code. In that case, you can report the service with CPT 99499 as an unlisted procedure.

You may bill a category III code available in combination with CPT code 99499.
You should attach a cover letter explaining the reason(s) for submitting an unlisted procedural code instead of a CPT code describing an E/M service if you report a procedure with an unlisted code.

Make sure to compare CPT codes similar to the provided service to justify billing an unlisted procedure. You can also include relevant documentation and operative notes in the cover letter to prove your claim and prevent a denial.

Third-party payers consider an unlisted E/M procedure (billed with the 99499 CPT code) case by case. Payment of the claim is usually determined based on documentation provided by you.

5. Resources

https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2282CP.pdf