Inpatient Care Prolonged Services: Description and Companion Codes
Prolonged services may be billed for direct, face-to-face inpatient services. The service must be on the same day of service as the primary service and performed by the same provider. The CPT code 99356 is for prolonged service, first hour. After the first hour, submit CPT code 99357 for each additional 30 minutes.
In determining whether prolonged services can be billed and to determine the prolonged services codes that are allowable, you may count only the duration of direct face-to-face contact with the patient which is beyond the typical/average time of the visit code billed (whether the service was continuous or not).
In the hospital setting, time spent reviewing charts or discussing the patient with house medical staff and not with direct face-to-face contact with the patient or waiting for test results, for changes in the patient’s condition, for end of a therapy, or for use of facilities cannot be used to calculate prolonged service time for the face-to-face code.
These codes require submission of an inpatient evaluation and management code as a companion code. Documentation for prolonged services must contain enough information to substantiate the medical necessity of the prolonged service and the start and end times of the visit must be documented.
Prolonged Inpatient E/M Services
CPT Code
|
Description
|
Time of Code
|
Companion Codes Required
|
---|---|---|---|
99356
|
Prolonged inpatient E/M, face-to face, beyond typical time, first hour
|
First hour; 30-74 minutes
|
an inpatient E/M code
|
99357
|
Prolonged inpatient E/M, face-to face, beyond typical time, each additional 30 minutes
|
Each added
30 minutes; bill after 75 minutes or more
|
an inpatient E/M code
and the 99356, first hour code
|
The table below details the codes that may be submitted as pre-requisites for inpatient prolonged services.
Initial Hospital Inpatient Care (CPT Codes 99221-99223)
Companion CPT Code
|
Level of Severity
|
Typical Time Spent
|
Key Components
Requires All 3 Components
|
---|---|---|---|
99221
|
Low
|
30 minutes
|
History- detailed or comprehensive
Exam – detailed or comprehensive
Medical decision making – straightforward or low complexity
|
99222
|
Moderate
|
50 minutes
|
History- comprehensive
Exam –comprehensive
Medical decision making – moderate complexity
|
99223
|
high
|
70 minutes
|
History- comprehensive
Exam –comprehensive
Medical decision making – high complexity
|
Subsequent Hospital Inpatient Care (CPT Codes 99231-99233)
Companion CPT Code
|
Level of Severity
|
Typical Time Spent
|
Key Components
Requires 2 of 3 Components
|
---|---|---|---|
99231
|
Stable, recovering, or improving
|
15 minutes
|
History- detailed or comprehensive
Exam – detailed or comprehensive
Medical decision making – straightforward or low complexity
|
99232
|
Minor complication;
Responding inadequately
|
25minutes
|
History- comprehensive
Exam –comprehensive
Medical decision making – moderate complexity
|
99233
|
Unstable,
significant complication
or new problem
|
35 minutes
|
History- comprehensive
Exam –comprehensive
Medical decision making – high complexity
|
Initial Nursing facility Care (CPT Codes 99304-99306)
Companion CPT Code |
Level of Severity
|
Typical Time Spent
|
Key Components
Requires All 3 Components
|
---|---|---|---|
99304
|
low
|
25 minutes
|
History- detailed or comprehensive
Exam – detailed or comprehensive
Medical decision making – straightforward or low complexity
|
99305
|
moderate
|
35 minutes
|
History- comprehensive
Exam –comprehensive
Medical decision making – moderate complexity
|
99306
|
high
|
45 minutes
|
History- comprehensive
Exam –comprehensive
Medical decision making – high complexity
|
Subsequent Nursing facility Care (CPT Codes 99307-99310)
Companion CPT Code
|
Level of Severity
|
Typical Time Spent
|
Key Components
Requires 2 of 3 Components
|
---|---|---|---|
99307
|
Stable
Recovering, or
Improving
|
10 minutes
|
History- problem focused interval
Exam – problem focused
Medical decision making – straightforward
|
99308
|
Minor complication;
Responding inadequately
|
15 minutes
|
History- problem focused, interval
Exam – problem focused
Medical decision making – low complexity
|
99309
|
Significant complication
or
Significant new problem
|
25 minutes
|
History- detailed interval
Exam – detailed
Medical decision making – moderate complexity
|
99310
|
Unstable
Or
Significant new problem
|
35 minutes
|
History- comprehensive interval
Exam –comprehensive
Medical decision making – high complexity
|
Annual Nursing Facility Assessment
Companion CPT Code
|
Level of Severity
|
Typical Time Spent
|
Key Components
Requires All 3 Components
|
---|---|---|---|
99318
|
Stable
Recovering, or
Improving
|
30 minutes
|
History- detailed interval
Exam – comprehensive
Medical decision making – low or moderate complexity
|
References
- Medicare Claims Processing Manual (PDF, 1.1 MB), Publication 100-04, Chapter 12, section 30.6.15.1.D