Can a provider submit charges for evaluation and management "Level 4" office visit and prolonged care if the reason for the prolonged care was based on the patient requiring an interpreter?

Answer:
Yes. An example would be if the total face-to-face evaluation and management (E/M) time was 55 minutes (25 minutes for CPT code 99214 plus 30 minutes over this time) or longer. In addition, the requirements for medical necessity of the service must also be met.

In this case, the medical necessity for the prolonged care was valid because of the patient’s inability to communicate. If time is considered the key or controlling factor in choosing the level of E/M service, then the prolonged services CPT codes (99354 through 99357) should only be used in addition if the service has exceeded 30 minutes beyond the highest level of E/M in the appropriate category.

Additional information is available in the Current Procedural Terminology (CPT) Manual.

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