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Medicare Now Pays for Prolonged Services Without Direct Face-to-Face Patient Contact

January 25, 2017:

Beginning January 1, 2017, CPT codes for prolonged services will be separately payable under Medicare. Up until now, payment for codes 99358 and 99359 was included in the payment for the related face-to-face evaluation and management code.

CPT codes 99358 and 99359 describe prolonged E/M services that are not face-to-face with the patient and must occur before or after a face-to-face service and relate to ongoing patient management. For example, a medical record might state: “A 65-year-old new patient with multiple problems is seen and evaluated. After the visit, the physician requires extensive time to talk with the patient's daughter, to review complex, detailed medical records transferred from previous physicians, and to complete a comprehensive treatment plan.” To use these codes, the service must be beyond the usual service provided by the physician or other qualified health care professional, may be reported with services other than E/M, and may occur on a different date from the date on which the related E/M service was provided.

Note that, to be paid, the codes cannot be reported during the same service period as complex chronic care or transitional care management services. They also cannot be reported for services without face-to-face time that can be described with more specific codes that have no upper time limit, such as those for care plan oversight, anticoagulant management, team conferences, or online medical evaluations. Because these services can be reported on a different date from the primary service, time spent beyond the usual time for the primary service is not a factor (unlike some other prolonged services codes, such as 99354). These are time-based codes, however, and describe services that may not be continuous and may occur over several days. Therefore, it is important to be precise when keeping track of time spent providing these non-face-to-face prolonged services.

99358 Prolonged evaluation and management service before and/or after direct patient care; first hour

99359 each additional 30 minutes (List separately in addition to code for prolonged service)

CPT © 2016 American Medical Association. All rights reserved.


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