prolonged evaluation and management service before and/or after direct (face-to-face) patient care, 2 hours. assign the cpt codes.

CPT 99354, CPT 99355, CPT 99356, CPT 99357, CPT 99358 & CPT 99359 (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.

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.

CPT 99354 can be reported along with CPT codes 90809, CPT 90815, CPT 99201 – CPT 99215, CPT 99241CPT 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 99221CPT 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 99281CPT 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 99374CPT 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 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); each additional 30 minutes.

CPT 99358 can be reported along with CPT code 99358).

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

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