Prolonged Services - A Quick Refresher!!!

This was info passed along to me from Gail E. in Boise... Thanks so much!


Prolonged Services

CPT codes 99354-99357 are designated within the CPT code set as add-on codes. The codes in this series are used to report the provision of prolonged physician service that involves direct (face-to-face) patient contact beyond the usual service (ie, beyond the typical time) in either the inpatient or outpatient setting. The term face-to-face is defined as only that time that the physician spends in direct, face-to-face contact with the patient. It is appropriate to report this service in addition to other physician services, including evaluation and management (E/M) services at any level. Appropriate codes should be selected for supplies provided or procedures performed in the care of the patient during this period.

99354-Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (eg, prolonged care and treatment of an acute asthmatic patient in an outpatient setting); first hour (List separately in addition to code for office or other outpatient Evaluation and Management service)

99355each additional 30 minutes (List separately in addition to code for prolonged physician service)

99356-Prolonged physician service in the inpatient setting, requiring direct (face-to-face) patient contact beyond the usual service (eg, maternal fetal monitoring for high risk delivery or other physiological monitoring, prolonged care of an acutely ill inpatient); first hour (List separately in addition to code for inpatient Evaluation and Management service)

99357 each additional 30 minutes

Example 1. - Provider spends a total of 2 hours with a patient counseling on such issues as depression, ADHD, medication side effects or providing an office visit with a patient through an interpreter. The majority of the visit content was counseling.
Coding would be 99215 (40 minutes)
99354 (1st hour of prolonged services)

Example 2. – Provider sees a patient in the Labor and Delivery unit of a hospital and provides prolonged observation and fetal monitoring. Total time spent with the patient was 2 hours- A minimal exam and history are taken.
99213 (15 minutes)
99354 (1st hour of prolonged services)
99355 (additional 30 minutes of prolonged services


• Total visit time must be documented to bill these services
• Remember to document in and out times

Medicare transmittal 1490 released April 11, 2008 clarifies that all prolonged service time must be face to face for Medicare patients