© 2021 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
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.
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 09/01/2020