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Printed Date: 9/22/2015
In situations where the minimum key component work and/or medical necessity requirements for initial hospital care (CPT codes 99221–99223) services are not met, subsequent hospital care CPT codes (99231 and 99232) could potentially meet requirements to be reported for the E/M service.
Reporting CPT code 99499 (unlisted evaluation and management service) should be limited to cases where there is no other specific E/M code payable by Medicare that describes that service. Reporting CPT code 99499 requires submission of medical records and contractor manual medical review of the service prior to payment. Reporting/billing under these circumstances are deemed to be unusual.
Resource: MLN Matters Article 7405 (PDF, 100 KB).
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Last Updated: 07/01/2019