New prolonged service CPT code for 2021

| September 21, 2020

New prolonged service CPT code for 2021

Beginning in 2021, there will be a new code for reporting prolonged services together with an office visit. The new code, CPT Code 99417, replaces CPT Codes 99354 and 99355. It can be used to report the total prolonged time with and without direct patient contact on the same day as an office visit. However, certain conditions apply:

  • It can only be reported in conjunction with the level 5 visit codes (CPT 99205, 99215).
  • The time must exceed the minimum time for primary E&M service.
  • Time alone must be the basis for coding.

For example, the range of time listed for 99205 is 60-74 minutes. The prolonged service code (99417) can be reported with 99205 when the total physician time exceeds the minimum time (60 minutes) for 99205 by at least 15 minutes. Thus, physician time, with and without patient contact, would need to be at least 75 minutes to report a prolonged service code. For an established patient visit, 99417 could be reported with 99215, when total time is at least 55 minutes. The code can be reported for each incremental 15-minute period.

CMS is proposing reimbursement of approximately $32 for this service.

Unsure about billing E&M codes based on time? Review our previous Insider article about the E/M changes taking effect in 2021, including the ability to choose codes based solely on time.

Be sure to stay up to date on coding and legislative changes.

During the College’s Annual Meeting, the Advocacy Council is hosting several opportunities to learn about the new codes for 2021 and any legislation that may impact your practice. These sessions will be presented by the College’s leading experts: Warner Carr, MD, FACAAI; Gary N. Gross, MD, FACAAI; James Sublett, MD, FACAAI; James Tracy, DO, FACAAI; and the College’s Washington consultant, Bill Finerfrock of Capitol Associates.

  • The Changing Payment System – Challenge Accepted!
    Friday, November 13 – 8:00 am CT
  • Practice Management in a Changing Landscape – Billing and Coding Update
    Friday, November 13 – 10:00 am CT
  • Coding and Government Relations
    Sunday, November 15 – 10:00 am CT

The College’s Annual Meeting registration is open and free to all College members – Register now! The registration deadline is Nov. 9.