Prolonged Physician Service With Direct (Face-to-Face) Patient Contact
►Codes 99354-99357 are used when a physician provides prolonged service involving direct (face-to-face) patient contact that is beyond the usual service in either the inpatient or outpatient setting. This service is reported in addition to the designated evaluation and management services at any level and any other physician services provided at the same session as evaluation and management services. Appropriate codes should be selected for supplies provided or procedures performed in the care of the patient during this period.
Codes 99354-99355 are used to report the total duration of face-to-face time spent by a physician on a given date providing prolonged service, even if the time spent by the physician on that date is not continuous. Codes 99356- 99357 are used to report the total duration of unit time spent by a physician on a given date providing prolonged services to a patient, even if the time spent by the physician on that date is not continuous
Code 99354 or 99356 is used to report the first hour of prolonged service on a given date, depending on the place of service.
Either code should be used only once per date, even if the time spent by the physician is not continuous on that date. Prolonged service of less than 30 minutes total duration on a given date is not separately reported because the work involved is included in the total work of the evaluation and management codes.
Code 99355 or 99357 is used…
The use of the time based add-on codes requires that the primary evaluation and management service have a
typical or specified time published in the CPT® codebook
The following examples illustrate the correct…
Total Duration of Prolonged Services Codes(s)
Less than 30 minutes (less than 1/2 hour) Not reported separately
30-74 minutes (1/2 hr. – 1 hr. 14 min.) 99354 X 1
75-104 (1 hr. 15 min. – 1 hr. 44 min.) 99354 X 1 AND 99355 X 1
►105 or more (1 hr. 45 min. or more) 99354 X 1 AND 99355 X 2
▲99354 Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face)
patient contact beyond the usual service; first hour (List separately in addition to code for office or
other outpatient Evaluation and Management Service)
►(Use 99354 in conjunction with 99201-99215, 99241-99245, 99324-99337, 99341-99350,
+▲99355 each additional 30 minutes (List separately in addition to code for prolonged physician service)
(Use 99355 in conjunction with 99354)
+▲99356 Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual
service; first hour (List separately in addition to code for inpatient Evaluation and Management
► (Use 99356 in conjunction with 99221-99233, 99251099255, 99304-99310, 90822, 90829)
▲99357 each additional 30 minutes (List separately in addition to code for prolonged physician service)
(Use 99357 in conjunction with 99356
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
CPT CODE and Description 90785 - Interactive complexity (List separately in addition to the code for primary procedure) 90791 - Psychi...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...
Procedure code and description 95806 - Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory air...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...