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

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)

Subsequent Hospital Inpatient Care (CPT Codes 99231-99233)

Initial Nursing facility Care (CPT Codes 99304-99306)

Subsequent Nursing facility Care (CPT Codes 99307-99310)

Annual Nursing Facility Assessment

References

• Medicare Claims Processing Manual (PDF, 1.1 MB), Publication 100-04, Chapter 12, section 30.6.15.1.D