Professional Services Where Time is a Primary Factor


While "time" has been included in the definitions of the majority of professional service codes for a number of years now, there is a difference between codes that list "typical" time and codes where time is a primary factor. Typical time noted in the code descriptors are averages that represent a range of times and are designed to assist providers with determining the most appropriate level of code.

In addition to codes that have a "typical" time component, there are a variety of professional codes where time is a primary factor in the code. However, even in cases where time is a primary component, there are differences in the requirements for utilizing these codes. It is important to review the requirements of a code prior to submitting it on a claim. Required time is the necessary time a provider spends rendering the service to the beneficiary, and the appropriate selection of the code includes a firm time basis. There are also codes within the Evaluation & Management code set that use approximate time thresholds, codes that involve a time range and codes that are "add-ons" for additional time spent rendering a service.

When selecting a code based on time, documentation must clearly reflect the time spent providing the service. The following time threshold reference tables include professional service codes from the Evaluation and Management code family with explicit minimum time requirements.

The information listed within this document is not an all-inclusive listing of time rated professional services and is for educational purposes only.

Hospital Discharge Management

CPT Code
Time

99238

30 minutes or less
99239
> than 30 minutes

Critical Care

CPT CodeTime
Bill appropriate E/M code; do not bill a critical care code < 30 minutes
99291
30–74 minutes
99292
Each additional 30 minutes

Domiciliary/Rest Home/Home Care Plan Oversight

CPT Code
Time

99339

15–29 minutes
99340
30 minutes or more

Prolonged Services

CPT Code
Time
Patient Contact

99354
Not reported separately

< 30 minutes With Direct Patient Contact
99354
30–74 minutes
 
99355
Each additional 30 minutes
 
99356
1st hour (60 minutes)
 
99357
Each additional 30 minutes
 
99358
1st hour (60 minutes)
Without Direct Patient Contact
99359
Each additional 30 minutes
 
99415
Not reported separately
< 45 minutes
Prolonged Clinical Staff Services
99415
45–74 minutes
 
99416
Each additional 30 minutes
 
99360
Not reported separately
< 30 minutes
Standby Services
99360
Each 30 minutes
 

Case Management Services

CPT Code
Time
Patient Contact
99366
Not reported separately
<30 minutes Medical Team Conference with Direct Patient/Family Contact
99366
30 minutes or more
 
99367
Not reported separately
< 30 minutes
Medical Team Conference without Direct Patient/Family Contact
99367
30 minutes or more
 

Care Plan Oversight Services

CPT Code
Time

99374

15–29 minutes
99375
30 minutes or more (add on code to 99374)
99377
15–29 minutes
99378
30 minutes or more (add on code to 99377)
99379
15–29 minutes
99380
30 minutes or more (add on code to 99379)

Preventive Medicine Services

CPT Code
Time
Individual/Group
99401
Approximately 15 minutes  Individual counseling
99402
Approximately 30 minutes
 
99403
Approximately 45 minutes
 
99404
Approximately 60 minutes
 
99406
>3 minutes and up to 10 minutes
Behavioral Change Interventions, Individual
99407
>10 minutes
 
99408
Not reported separately
<15 minutes
 
99408
15–30 minutes
 
99409
>30 minutes
 
99411
Approximately 30 minutes
Group Counseling
99412
Approximately 60 minutes
 

Non Face-to-Face Services

CPT Code
Time
Type of Service

99441

5–10 minutes Telephone Services
99442
11–20 minutes
 
99443
21–30 minutes
 
99446
5–10 minutes
Interprofessional Telephone/Internet Consultations
99447
11–20 minutes
 
99448
21–30 minutes
 
99449
31 minutes or more
 

Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services

CPT Code
Time
99466
First 30–74 minutes
99467
Each additional 30 minutes (add on to code 99466)
99485
First 30 minutes
99486
Each additional 30 minutes (add on to code 99485)

Care Management Services (Chronic Care)

CPT Code
Time
99487
60 minutes (do not report services of <60 minutes)
99489
Each additional 30 minutes (add on code to 99487)
99490
20 minutes or greater

Transitional Care Management Services

CPT Code
Time

99497

Advance care planning, first 30 minutes
99498
Each additional 30 minutes (add on code to 99497)


E/M References

This document was developed through the A/B Medicare Administrative Contractor (MAC) Provider Outreach and Education (POE) Collaboration Team. This joint effort ensures consistent communication and education throughout the nation on a variety of topics and will assist the provider and physician community with information necessary to submit claims appropriately and receive proper payment in a timely manner.





Last Updated: 08/03/2020