Prolonged Services billing is allowed by Medicare in the Office, other Outpatient and Inpatient settings, the Prolonged Service codes are used as add-on codes to E&M codes to indicate the extra time that the Physician has spent face-to-face with the patient.
The Prolonged Service codes are billed based on the length of time spent with the patient beyond the usual time required for the E&M code billed, the time spent with the patient need not be continuous but it must be time spent in one calendar day and must be time spent face-to-face with the patient.
For Office/Outpatient settings :
CPT 99354 can be billed when the provider spends direct face-to-face time of more than one hour beyond the usual service/typical time for the E&M code. Additional 30 minutes of face-to-face time with patient can be reported by CPT Code 99355.
For Inpatient settings :
CPT 99356 can be billed when the provider spends direct face-to-face time of more than one hour beyond the usual service/typical time for the E&M code.
Additional 30 minutes of face-to-face time with patient can be reported by CPT Code 99357.
Prolonged service cannot be billed when the prolonged service duration is less than 30 minutes as then it would be considered as included in the E&M code billed.
Prolonged services of less than 15 minutes beyond first hour or less than 15 minutes beyond the final 30 minutes cannot be billed.
As regards the documentation, the documentation needs to be explicit, documentation is required to be in the medical record about the duration and content of the medically necessary evaluation and management service and prolonged services that you bill.
You must sufficiently document in the medical record that you personally furnished the direct face-to-face time with the patient specified in the CPT code definitions. The progress note has to have the start and end times of the visit, along with the date of service.
The Prolonged Service codes are billed based on the length of time spent with the patient beyond the usual time required for the E&M code billed, the time spent with the patient need not be continuous but it must be time spent in one calendar day and must be time spent face-to-face with the patient.
For Office/Outpatient settings :
CPT 99354 can be billed when the provider spends direct face-to-face time of more than one hour beyond the usual service/typical time for the E&M code. Additional 30 minutes of face-to-face time with patient can be reported by CPT Code 99355.
For Inpatient settings :
CPT 99356 can be billed when the provider spends direct face-to-face time of more than one hour beyond the usual service/typical time for the E&M code.
Additional 30 minutes of face-to-face time with patient can be reported by CPT Code 99357.
Prolonged service cannot be billed when the prolonged service duration is less than 30 minutes as then it would be considered as included in the E&M code billed.
Prolonged services of less than 15 minutes beyond first hour or less than 15 minutes beyond the final 30 minutes cannot be billed.
Total time of Prolonged services
|
Outpatient
|
Inpatient
|
(do not include visit code time)
|
Prolonged Services Code
|
Prolonged Services Code
|
Less than 30 minutes
|
Not reported
|
Not reported
|
30 – 74 minutes
|
99354
|
99356
|
75 – 104 minutes
|
99354 and 99355
|
99356 and 99357
|
As regards the documentation, the documentation needs to be explicit, documentation is required to be in the medical record about the duration and content of the medically necessary evaluation and management service and prolonged services that you bill.
You must sufficiently document in the medical record that you personally furnished the direct face-to-face time with the patient specified in the CPT code definitions. The progress note has to have the start and end times of the visit, along with the date of service.
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