Prolonged Service Codes

By W. Bruce Milliman, ND, and Eva Miller, ND (AMA - CPT/Editorial Panel/HCPAC, representing the AANP)

There is one statement we hear over and over by our naturopathic colleagues in response to contracting with insurance and that is "We aren't reimbursed adequately for time". There are several ways within CPT to code for time, one of which is discussed below.

We sill start with explaining the Prolonged Physician Service codes in CPT. Codes 99354 and 99355 are used in addition to Evaluation and Management (E/M) codes (99211-99215/99201-99205) when a physician provides a prolonged service directly to a patient in an outpatient setting that is beyond the typical examination.

Code 99354 is used to report the first hour (between 30-74 min) of prolonged services. Added time less than 30 min beyond that which is included in the underlying E/M code cannot be separately reported. Code 99355 is used for each additional 30 minutes beyond the first hour.

The key points here are:

  • That these codes are for use only in conjunction with a performed E/M service (99201- 99215, 99241-99245, 99324 - 99337, 99341-99350).
  • That the prolonged service can only be used after the time allotted for the designated E/M service has elapsed. For example, the patient is seen for a 99213 (15 min) plus an additional 30-74 minutes. Assuming appropriate care and documentation, this interaction is correctly coded as a 99213 + 99354.
We will discuss other coding options with regard to time in the next article.

We welcome your questions about coding and CPT, so feel free to contact us.