AMA Provides Prolonged Services Coding Changes for CPT 2021*

In addition to the changes to standard office visit coding (99202-99215) discussed in the November 5, 2020 blog (CLICK HERE), there is a new Evaluation and Management (E/M) coding process that will impact practitioners’ coding choices when cases demand additional time over and above the highest levels cited in E/M descriptors.  It is important to note that HMA does not provide coding advice, rather, we work with outside coding experts to assist HMA clients on coding and documentation related questions.

The full descriptor for the newest code (+99417 previously referenced as 99XXX) is cited below:

• +99417 (Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services)).

This new code shows a guideline preceding the descriptor in CPT 2021* for +99417.  It states that when a time-based E/M coding scenario reaches and exceeds the highest level service (99205 or 99215), each 15 minute period over that allotted time should be billed as one unit of 99417. 

Additional information for code 99417 is cited in CPT 2021 using the chart below:

There are two additional revised outpatient setting codes provided for specified use “except with office or other outpatient services” that must be addressed before coding these services:

99354 Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; first hour (List separately in addition to code for outpatient Evaluation and Management or psychotherapy service, except with office or other outpatient services [99202-99215])

(Use 99354 in conjunction with 90837, 90847, 99241-99245, 99324-99337, 99341-99350, 99483)

(Do not report 99354 in conjunction with 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99415, 99416, 99XXX)

«Êp99355 each additional 30 minutes (List separately in addition to code for prolonged service)

(Use 99355 in conjunction with 99354)

(Do not report 99355 in conjunction with 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99415, 99416, 99XXX)

There are also two additional revised inpatient/observation setting codes provided for specified use that must be addressed before coding these services:

Êp99356 Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient or observation Evaluation and Management service)

(Use 99356 in conjunction with 90837, 90847, 99218-99220, 99221-99223, 99224-99226, 99231-99233, 99234-99236, 99251-99255, 99304-99310)

Ê99357 each additional 30 minutes (List separately in addition to code for prolonged service)

(Use 99357 in conjunction with 99356)

The AMA has provided a chart showing the logic to be applied to this coding:

The full AMA document is attached: (CLICK HERE)

*CPT is a registered trademark of the American Medical Association. Copyright 2019 American Medical Association. All rights reserved.