Prolonged Service With or Without Direct Patient Contact on the Date of an Evaluation and Management Service

Question:

If using the prolonged service codes, does the level of the E/M service have to meet level 5 criteria?

Answer:

Yes, the prolonged service codes are onlyreportedwith the highest level ofoffice/outpatientvisitEvaluation and Management (E/M) code(e.g.,99205, 99215, 99245)whenthetime requirementhasbeen satisfied. Prolonged services of less than 15 minutesarenotseparatelyreported. Prolonged service codes arereported whenchoosing an E/M code based ontime, notMedical DecisionMaking.

CPT allowsreporting add-on code+99417( Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time)at 15 minutes AFTER the minimumtime in the range for the office/outpatient visitE/M code.

CMS has created prolonged serviceadd-oncode+G2212 to be used instead of+99417. CMS (Medicare) allowsreporting+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)at 15 minutesonlyAFTER the maximumtime in the ranges for the office/outpatient visitE/M code is met.