Friday, November 4, 2011

CPT code 99357

CPT 99357 with E&M Services

CPT-4 Code 99357 To report prolonged inpatient E&M services, CPT-4 codes 99357 (each additional 30 minutes) must be billed in conjunction with code 99356.

Billing Calculations CPT-4 codes 99356 and 99357 are subject to the least restrictive frequency limitation as the required companion code. To calculate the amount of time that is payable for prolonged inpatient services, take the total unit/floor time and subtract the time of the primary E&M service. The following table may be used to calculate billing for prolonged inpatient E&M services.



Time of E&M visit code not included                  First hour               Each additional 30 minutes

Less than 30 minutes                                       Not reported               Not reported

30 – 74 minutes                                               99356                        Not reported

75 – 104 minutes                                             99356                        99357

105 – 134 minutes                                           99356                       99357 (quantity of 2)

135 – 164 minutes                                           99356                       99357 (quantity of 3)

165 – 194 minutes                                          99356                        99357 (quantity of 4)
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download