(2023) How To Code Prolonged Services (CPT 99354 – CPT 99359)

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.

List With CPT Codes For Prolonged Services

The following CPT codes can be used while coding prolonged services; CPT 99354, CPT 99355, CPT 99356, CPT 99357, CPT 99358 & CPT 99359. Underneath the descriptions of the CPT codes.

CPT 99354

Description of CPT 99354: Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; first hour.

TIP: You can find the billing guide for CPT 99354 here.

CPT 99354 can be reported along with CPT codes 90809, CPT 90815, CPT 99201 – CPT 99215, CPT 99241 – CPT 99245, CPT 99324 – CPT 99337 and CPT 99341 – CPT 99350.

CPT 99355

Description of CPT 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.

CPT 99355 can reported along with CPT code 99354.

CPT 99356

Description of CPT 99356: Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour.

CPT 99356 can be reported along with CPT codes 90822, CPT 90829, CPT 99221 – CPT 99233, CPT 99251 – CPT 99255 and CPT 99304 – CPT 99310).

CPT 99357

Description of CPT 99357: Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; each additional 30 minutes.

CPT 99357 can be reported along with CPT 99356.

CPT 99358

Description of CPT 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.

CPT 99358 can be be reported along with CPT codes 99201 – CPT 99215, CPT 99217 – CPT 99239, CPT 99241 – CPT 99255, CPT 99281 – CPT 99285, CPT 99288, CPT 99291, CPT 99304 – CPT 99318, CPT 99324 – CPT 99337, CPT 99339 – CPT 99350, CPT 99363 – CPT 99364, CPT 99366 – CPT 99368, CPT 99374 – CPT 99375, CPT 99377 – CPT 99380, CPT 99397, CPT 99401 – CPT 99409, CPT 99411 – CPT 99412, CPT 99420, CPT 99450, CPT 99455 – CPT 99456, CPT 99460 – CPT 99466, CPT 99468 – CPT 99480.

CPT 99359

Description of CPT 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.

CPT 99358 can be reported along with CPT code 99359.

Coding Guidelines For Prolonged Services

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