Office-Based Prolonged Services Changes

Reminder: Guidance only applies to CPT® codes 99202-99215

Summary of Prolonged Services Changes

• New CPT Code
  99417 - Prolonged office or other outpatient evaluation and management service(s) (beyond the total time of the primary procedure which has been selected using total time), requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service; each 15 minutes
  
  (List separately in addition to codes 99205, 99215)
  
  (Do not report 99417 in conjunction with 99354,99355, 99358, 99359, 99415, 99416)
  
  (Do not report 99417 for any time unit less than 15 minutes)
• Only reported when your office-based E/M service is reported based on time
• Only reported when you exceed the time spent in 99205 or 99215 (see CPT Threshold Chart)
• Reported “per 15 minutes” beyond the first 99417 (See CPT Prolonged Services chart)
• The Medicare physician fee schedule did not publish the recommended value for code 99417

CMS Update:

On December 1, 2020 the Centers for Medicare and Medicaid released the 2021 final rule for the Physician Fee Schedule. In the final rule was notification from CMS that while they recognize prolonged services, they disagree with CPT on the threshold time needed to allow the reporting of prolonged services. To that end, CMS released a different code that is billable to Medicare.

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 (List separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and mana

• Do not report G2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416
• Do not report G2212 for any time unit less than 15 minutes
• Only reported when your office-based E/M service is reported based on time
• Only reported when you exceed the time spent in 99205 or 99215 (see CMS Threshold Chart)
• Reported “per 15 minutes” beyond the first

Charts:

CPT Time Threshold Chart for Prolonged Services

CMS Time Threshold Chart for Prolonged Services

CPT Prolonged Services for Office/Outpatient E/M Services

This chart demonstrates how the 99417 is reported if the payer is following CPT logic. Work with your payers to know how they want this to be reported.

CMS Prolonged Services for Office/Outpatient E/M Services

This chart demonstrates how the G2212 is reported if the payer is following CMS logic. Work with your payers to know how they want this to be reported.