Full Answer
How much does a CPT 99354 cost?
CPT 99354– Prolonged physician service in the office or other outpatient setting, requiring direct (face-to-face) patient contact beyond the usual service – first hour (List separately in addition to code for office or other outpatient Evaluation and Management service) –average fee payment – $100 – $120
Will Medicare pay for a 99358 code?
Finally, you should remember that Medicare contractors will not pay (nor can you bill the patient) for prolonged services codes 99358 and 99359, which do not require any direct patient F2F contact (e.g., telephone calls). These are Medicare covered services and payment is included in the payment for other billable services.
Can psychotherapists get reimbursed with 99354?
This means many Licensed Clinical Social Workers (LCSW), Licensed Professional Counselors (LPC), Licensed Marriage Family Therapist (LMFT), clinical psychologists and psychiatrists can get reimbursed with 99354. It is still not commonly known and isn’t billed very frequently, but is a great way to be compensated for extended psychotherapy sessions.
What is the difference between 90837 and 99354?
For mental health professionals, the 99354 is almost always billed with 90837 or 90847. 90837 is defined as 60 minutes, whereas 90847 is defined as 50 minutes. Since 99354 needs to be at least an additional 30 minutes, sessions need to be at least 30 minutes longer beyond the other procedure code. 53-89 minute session – 90837.
Does Medicare pay for 99354?
In the office or other outpatient setting, Medicare will pay for prolonged physician services (CPT code 99354) (with direct face-to-face patient contact that requires one hour beyond the usual service), when billed on the same day by the same physician or qualified NPP as the companion evaluation and management codes.
What is Medicare fee-for-service?
Fee-for-service is a system of health care payment in which a provider is paid separately for each particular service rendered. Original Medicare is an example of fee-for-service coverage, and there are Medicare Advantage plans that also operate on a fee-for-service basis.
When can you use CPT code 99354?
Prolonged physician services (CPT code 99354) in the office or other outpatient setting with direct face-to-face patient contact which require one hour beyond the usual service are payable when billed on the same day by the same physician or qualified nonphysician practitioner (NPP) as the companion evaluation and ...
Do you need a modifier for 99354?
Yes. They claim that 99354 and 96365 cannot be billed together without a modifier.
What are some examples of fee-for-service?
A method in which doctors and other health care providers are paid for each service performed. Examples of services include tests and office visits.
What is the difference between FFS and PPS?
Compared to fee-for-service plans, which reward the provider for the volume of care provided and can create an incentive for unnecessary treatment, the PPS payment is based on multiple factors including service location and patient diagnosis.
Can CPT code 99354 be billed alone?
CPT Code 99354 is a prolonged service CPT code add-on. It cannot be billed alone and must be billed with an appropriate procedure code.
How many minutes is CPT 99354?
Prolonged Services With PsychotherapyTotal Duration of Prolonged ServicesProcedure Code(s)75–104 minutes (one hour, 15 minutes–one hour, 44 minutes)99354 x 1* and 99355 x 1*105 or more minutes (one hour, 45 minutes or more)99354 x 1* and 99355 x 2* or more for each additional 30 minutes2 more rows
What is the modifier for 99354?
modifier 25May a physician or other qualified health care professional report prolonged services (CPT codes 99354- 99357) with modifier 25 when a significant and separately identifiable E/M service is performed along with a separate service or procedure?
What is the difference between 99354 and 99355?
CPT Code 99355 Time Length For mental health professionals, the 99355 is almost always billed with 90837 or 90847. In addition, the first amount of extra time must be billed with 99354. Only if both 90837/90847 and 99354 have been appropriately billed can the extra time be billed with 99355.
Does Medicare cover prolonged services?
Finally, you should remember that Medicare contractors will not pay (nor can you bill the patient) for prolonged services codes 99358 and 99359, which do not require any direct patient F2F contact (e.g., telephone calls).
What is the difference between 99354 and 99417?
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).
How many units of 99354 are acceptable?
No more than one unit of 99354 is acceptable. • If the total direct face-to-face time equals or exceeds the threshold time for code 99355 by no more than 29 minutes, provider should bill the visit code 99354 and one unit of code 99355.
What is the CPT code for a patient who is required to spend 15 minutes before and/or after direct (
Where the physician is required to spend 15 or more minutes before and/or after direct (face-to-face) patient contact in reviewing extensive records, tests or in communication with other professionals, the CPT code 99358 may be charged in addition to the basic charge for the appropriate Evaluation and Management code.
What is the CPT code for a physician's office visit?
A physician performed a visit that met the definition of an office visit CPT code 99213 and the total duration of the direct face-to-face services (including the visit) was 65 minutes. The physician bills CPT code 99213 and one unit of code 99354.
What is the CPT code for a domiciliary visit?
A physician performed a visit that met the definition of a domiciliary, rest home care visit CPT code 99327 and the total duration of the direct face-to-face contact (including the visit) was 140 minutes. The physician bills CPT codes 99327, 99 354, and one unit of code 99355.
How long is a 99213 visit?
A physician performed a visit that met the definition of code 99213 and, while the patient was in the office receiving treatment for 4 hours, the total duration of the direct face-to-face service of the physician was 40 minutes. The physician cannot bill prolonged services because the total duration of direct face-to-face service did not meet ...
How long is 99214?
The physician cannot code 99214, which has a typical time of 25 minutes, and one unit of code 99354. The physician must bill the highest level code in the code family (99215 which has 40 minutes typical/average time units associated with it).
Why can't a physician bill for prolonged services?
The physician cannot bill prolonged services because the total duration of direct face-to-face service did not meet the threshold time for billing prolonged services. EXAMPLE 3. A physician provided a subsequent office visit that was predominantly counseling, spending 60 minutes (face-to-face) with the patient.
What is the 99354 code?
Codes 99354-99355 are used to report the total duration of face-to-face time spent by a physician on a given date providing prolonged service, even if the time spent by the physician on that date is not continuous. ...
When to use 99354-99357?
►Codes 99354-99357 are used when a physician provides prolonged service involving direct (face-to-face) patient contact that is beyond the usual service in either the inpatient or outpatient setting. This service is reported in addition to the designated evaluation and management services at any level and any other physician services provided at the same session as evaluation and management services. Appropriate codes should be selected for supplies provided or procedures performed in the care of the patient during this period.
What is the code for a physician to report the first hour of service?
Code 99354 or 99356 is used to report the first hour of prolonged service on a given date, depending on the place of service. Either code should be used only once per date, even if the time spent by the physician is not continuous on that date.
What is the code for a physician to report the duration of unit time spent on a given date?
Codes 99356- 99357 are used to report the total duration of unit time spent by a physician on a given date providing prolonged services to a patient, even if the time spent by the physician on that date is not continuous.
What is a 99354-99357?
Prolonged Service with Direct Patient Contact (99354-99357) Direct patient contact is Face-to-Face (F2F) and includes additional non-F2F services on the floor/unit in hospital or nursing facility during the same session. Reported in addition to the primary procedure.
What is the CPT code for a rest home care visit?
A physician performed a visit that met the definition of a domiciliary, rest home care visit CPT code 99327 and the total duration of the direct F2F contact (including the visit) was 140 minutes. The physician bills CPT codes 99327, 99 354, and one unit of code 99355. EXAMPLE 3.
What is the CPT code for a physician's office visit?
A physician performed a visit that met the definition of an office visit CPT code 99213 and the total duration of the direct F2F services (including the visit) was 65 minutes. The physician bills CPT code 99213 and one unit of code 99354.
How long is a 99213 visit?
A physician performed a visit that met the definition of code 99213 and, while the patient was in the office receiving treatment for 4 hours, the total duration of the direct F2F service of the physician was 40 minutes.
How long is 99214?
The physician cannot code 99214, which has a typical time of 25 minutes, and one unit of code 99354. The physician must bill the highest level code in the code family (99215 which has 40 minutes typical/average time units associated with it).
Why can't a physician bill for prolonged services?
The physician cannot bill prolonged services because the total duration of direct F2F service did not meet the threshold time for billing prolonged services. EXAMPLE 3. A physician provided a subsequent office visit that was predominantly counseling, spending 60 minutes (F2F) with the patient.
What is the code for extended office/outpatient evaluation and management?
Effective January 1, 2021, the Centers for Medicare & Medicaid Services (CMS) has finalized HCPCS code G2212 for prolonged office/outpatient evaluation and management (E/M) visits. HCPCS code G2212 is to be used for billing Medicare for prolonged office/outpatient E/M visits instead of CPT codes 99358, 99359 or 99417, ...
What is the code for a prolonged service?
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.
When will Medicare start charging for PFS 2022?
The CY 2022 Medicare Physician Fee Schedule Proposed Rule with comment period was placed on display at the Federal Register on July 13, 2021. This proposed rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2022.
When is the Medicare Physician Fee Schedule 2020?
This final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2020.
When is the 2021 Medicare PFS final rule?
The CY 2021 Medicare Physician Fee Schedule Final Rule was placed on display at the Federal Register on December 2, 2020. This final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2021.
When will CMS accept comments?
CMS will accept comments on the proposed rule until September 13, 2021, and will respond to comments in a final rule. The proposed rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection.
