Prolonged Service Code

CMS newly created HCPCS code G2212 is to be used for billing Medicare for prolonged Evaluation and Management (E/M) services which exceed the maximum time for a level five (99205, 99215) office/outpatient E/M visit by at least 15 minutes on the date of service. CPT codes 99358, 99359 or 99417 may no longer be billed with 99202 - 99215 codes for dates of service on and after January 1, 2021.

Procedure Code

CPT/HCPCS Code(s) Descriptor
G2212 Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact.

 

  • List separately in addition to CPT® codes 99205, 99215 for office or other outpatient evaluation and management services
  • Do not report G2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, or 99416
  • Do not report G2212 for any time unit less than 15 minutes
  • Cannot be reported for less than 15 minutes
  • CPT code 99417 is not valid for Medicare reimbursement

Reporting times

When the time of the reporting practitioner is used to select the office/outpatient E/M visit level, HCPCS code G2212 could be reported when the maximum time for the highest level (level five) office/outpatient E/M visit (99205 or 99215) is exceeded by at least 15 minutes on the date of the service.

Prolonged Office/Outpatient E/M Visit Reporting - New Patient

CPT/HCPCS Code(s) Total Time Required for Reporting *
99205 60-74 minutes
99205 x 1 and G2212 x 1 89-103 minutes
99205 x 1 and G2212 x 2 104-118 minutes
99205 x 1 and G2212 x 3 or more
(for each additional 15 minutes)
119 or more

 

Prolonged Office/Outpatient E/M Visit Reporting - Established Patient

CPT/HCPCS Code(s) Total Time Required for Reporting*
99215 40-54 minutes
99215 x 1 and G2212 x 1 69-83 minutes
99215 x 1 and G2212 x 2 84-98 minutes
99215 x 1 and G2212 x 3 or more
(for each additional 15 minutes)
99215 x 1 and G2212 x 3 or more
(for each additional 15 minutes)

 

*Total time is the sum of all time, with and without direct patient contact including prolonged time, spent by the reporting practitioner on the date of service for the encounter.

Documentation about the duration and content of the medically necessary E/M service and prolonged service(s) billed is required in the medical record. The medical record must be appropriately and sufficiently documented by the physician or qualified Non-Physician Practitioner (NPP) to show that the physician or qualified NPP personally furnished the direct face-to-face time with the patient specified in the CPT code definitions.

The start and end times, or total time, of the visit should be documented in the medical record along with the date of service.

Additional Prolonged Service Codes

Codes 99354-99357 are used when a physician or other qualified health care professional provides prolonged service(s) involving direct patient contact that is provided beyond the usual evaluation and management (E/M) service in either the inpatient or outpatient setting for E/M codes other than the 99202 - 99215.

Direct patient contact is face-to-face and includes additional non-face-to-face services on the patient's floor/unit in the hospital or nursing facility during the same service.

Procedure codes

CPT Codes Descriptor
99354 Prolonged E/M in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour
99355 Each additional 30 minutes (list separately in addition to code for prolonged service)
99356 Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour
99357 Each additional 30 minutes (list separately in addition to code for prolonged service

 

Prolonged Services without Direct Face-to-Face Patient Contact

Codes 99358-99359 are used when a prolonged service is provided that is neither face-to-face time in the office or outpatient setting, nor additional unit/floor time in the hospital or nursing facility setting during the same session of an E/M, and is beyond the usual physician or other qualified health care professional service time.

Report these codes in relation to other physician or other qualified health care professional services, including E/M at any level. With the exception of the 99205-99215 codes on the same day of service as it is a bundled service.  These codes may be reported on a different date than the primary service to which it is related.

Procedure Codes

CPT Codes Descriptor
99358 Prolonged E/M before and/or after direct patient care; first hour
99359 Each additional 30 minutes (list separately in addition to code for prolonged service)

 

Cannot be reported during the same service period as complex Chronic Care Management (CCM) services or transitional care management services.

They are not reported for time spent in non-face-to-face care described by more specific codes having no upper time limit in the CPT code set.

Can only be used to report extended qualifying time of the billing physician or other practitioner (not clinical staff).

Cannot be reported in association with a companion E/M code that also qualifies as the initiating visit for CCM services. Practitioners should instead report the add-on code for CCM initiation, if applicable.

References

 

Last Updated Fri, 19 Feb 2021 16:15:10 +0000