Documenting Prolonged Care
Documentation is required in the medical record about the duration and content of the medically necessary evaluation and management (E/M) visit and prolonged services billed.
G2212: Prolonged Outpatient Office E/M Services
The Centers for Medicare & Medicaid Services (CMS) offers information and examples of prolonged outpatient office E/M visits and the utilization of HCPCS add-on code G2212. The total time required for reporting is equal to the sum of all time, including prolonged time, spent by the reporting practitioner on the date of service of the visit. This time specific information must be identifiable within the medical record documentation.
| HCPCS Codes | Total Time Required |
|---|---|
| 99205 | 60–74 minutes |
| 99205 x 1 and G2212 x 1 | 89–103 minutes |
| 99205 x 1 and G2212 x 2 | 104–118 minutes |
| 99215 | 40–54 minutes |
| 99215 x 1 and G2212 x 1 | 69–83 minutes |
| 99215 x 1 and G2212 x 2 | 84–98 minutes |
| 99215 x 1 and G2212 x 3 or more for each additional 15 minutes | 99 or more |
HCPCS Code 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 and 99483 for office or other outpatient evaluation and management services.)
Do not report G2212 for any time unit less than 15 minutes, or on the same date of service as 99354, 99355, 99358, 99359, 99415 or 99416.
Refer to MLN006764: Evaluation and Management Services Guide 09.2024 (PDF) for the most up-to-date changes regarding prolonged services.