Sometimes I spend additional time with a patient and/or reviewing records beyond what a level 5 evaluation or consultation code allows. Can I bill for this, and how?
Medicare does not allow billing of the prolonged service codes for non face-to-face time (99358-99359) but does allow for billing the prolonged service codes for face-to-face time (99354-99357) if the service is medically necessary. Assuming you have billed the initial service as an outpatient visit, either a consultation or New or Established the prolonged service codes may be billed, dependent upon payer, for times greater than 30 minutes above and beyond the period of time indicated in the E/M code billed according to the table included in the CPT manual in the introduction to the prolonged service codes (99354-99359). Again, Medicare will not pay for non face-to-face time. The only available option for billing for the extra time spent when the prolonged service codes are not allowed is the use of modifier –21 appended to the E/M service. This modifier, like modifier –22, will require documentation to be submitted with the claim and manual review will determine if and how much extra
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