What is procedure code 99356?

What is procedure code 99356?

Code 99356: Prolonged physician service in the inpatient setting requiring direct (face-to-face) patient contact beyond the usual service (e.g., maternal fetal monitoring for high risk delivery or other physiological monitoring); the first hour. Code 99357: Each additional 30 minutes.

What is procedure code 99417?

CPT® Code 99417 – Prolonged Service With or Without Direct Patient Contact on the Date of an Office or Other Outpatient Service – Codify by AAPC.

Is CPT 99417 covered by Medicaid?

Effective January 1, 2021 CPT code 99417 and HCPCS code G2212 are used to report prolonged services with CPT codes 99205 and 99215 only. b. CPT code 99417 is listed on the OHA prioritized list as a covered service, but G2212 is not currently listed. Moda Health will accept 99417 for processing for Medicaid plans.

When should I use 99356?

Prolonged physician services (code 99356) in the inpatient setting, with direct face-to- face patient contact which require one hour beyond the usual service are payable when they are billed on the same day by the same physician or qualified NPP as the companion evaluation and management codes.

Can 99233 and 99356 be billed together?

But CPT code 99233 has an approximate time of only 35 minutes, while your total encounter was 75 minutes. You should therefore bill using 99233 (35 minutes) and 99356 (prolonged care up to one hour).

Does Medicare recognize 99417?

CMS does not agree with the AMA about the use of prolonged services code 99417 and has assigned 99417 as invalid for Medicare. Instead, CMS released HCPCS code G2212 to be used when billing 15 minutes of prolonged services for Medicare, including Medicare Advantage members.

Does Blue Cross cover CPT 99417?

The plan of care must also be present and support the need for prolonged care. If a denial is appealed, this documentation must be submitted with the appeal. Blue Cross and Blue Shield of Minnesota (Blue Cross) provides reimbursement for prolonged physician services codes 99354-99357 and 99415-99417.

Does Medicare pay for 99356?

CMS (page 2): In the inpatient setting , Medicare will pay for prolonged physician services code 99356 with direct face-to-face patient contact which require 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.

Can CPT 99356 be billed alone?

To bill a 99356 alone or with a 99357, the time spent with the patient does not have to be continuous. It must, however, all be spent on one calendar day and face-to-face.

Does 99356 need a modifier?

Then, you must spend at least 35 additional minutes face-to-face counseling the patient—to satisfy the 50%- plus time requirement—before you can bill a 99356. While these codes don’t require any modifiers, they all need meticulous documentation.

Do I need a modifier for 99417?

Guru. 99417 is an add on code. There is no modifier on either code.

Is CPT 99417 covered by Medicare?

What is the difference between CPT 99417 and G2212?

In an interesting move by CMS, they created code G2212 to be used INSTEAD of 99417 to report prolonged office Evaluation and Management (E/M) services. This change took place effective January 1, 2021.

Can 99215 and 99417 be billed together?

CPT ® code 99417 may only be reported in conjunction with 99205 or 99215 if the codes were selected based on the time alone and not medical decision making. A service of less than 15 minutes should not be reported.

Does 99215 and 99417 need a modifier?

99417 is an add on code. There is no modifier on either code.

Do you use modifier 25 with 99417?