Prolonged Physician Services

Prolonged Services with Direct Patient Contact

Codes 99354-99357 are used when a physician or other qualified health care professional provides prolonged service(s) involving direct patient contact that is provided beyond the usual evaluation and management (E/M) service in either the inpatient or outpatient setting.

Direct patient contact is face-to-face and includes additional non-face-to-face services on the patient's floor/unit in the hospital or nursing facility during the same service.

Report these services in addition to the primary E/M service.

Procedure codes

Prolonged Services without Direct Face-to-Face Patient Contact

Codes 99358-99359 are used when a prolonged service is provided that is neither face-to-face time in the office or outpatient setting, nor additional unit/floor time in the hospital or nursing facility setting during the same session of an E/M and is beyond the usual physician or other qualified health care professional service time.

Report these codes in relation to other physician or other qualified health care professional services, including E/M at any level. These may be reported on a different date than the primary service to which it is related.

Procedure codes

Beginning Calendar Year (CY) 2017, these codes are separately payable under the Medicare Physician Fee Schedule.

Documentation

Documentation about the duration and content of the medically necessary evaluation and management service and prolonged services billed is required in the medical record. The medical record must be appropriately and sufficiently documented by the physician or qualified NPP to show that the physician or qualified NPP personally furnished the direct face-to-face time with the patient specified in the CPT code definitions.

The start and end times of the visit should be documented in the medical record along with the date of service.

Prolonged Office/Outpatient E/M Visits

CMS created the new HCPCS code G2212 to bill Medicare for prolonged E/M services which exceed the maximum time for a level five office/outpatient E/M visit by at least 15 minutes on the date of service.

Effective January 1, 2021, the Centers for Medicare & Medicaid Services (CMS) has finalized HCPCS code G2212 for prolonged office/outpatient evaluation and management (E/M) visits. HCPCS code G2212 is to be used for billing Medicare for prolonged office/outpatient E/M visits instead of CPT codes 99358, 99359 or 99417, for dates of service on and after January 1, 2021.

Code descriptor

HCPCS code G2212: Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact.

(List separately in addition to CPT® codes 99205, 99215 for office or other outpatient evaluation and management services)

(Do not report G2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416)

(Do not report G2212 for any time unit less than 15 minutes).

Reporting times

When the time of the reporting practitioner is used to select the office/outpatient E/M visit level, HCPCS code G2212 could be reported when the maximum time for the highest level (level five) office/outpatient E/M visit (99205 or 99215) is exceeded by at least 15 minutes on the date of the service.

Prolonged Office/Outpatient E/M Visit Reporting -- New Patient

Prolonged Office/Outpatient E/M Visit Reporting -- Established Patient

*Total time is the sum of all time, with and without direct patient contact and including prolonged time, spent by the reporting practitioner on the date of service of the visit.

References