November 12, 2016

Additional Reimbursements for Prolonged Services

By admin

Add-on codes for Prolonged Services +99354 and +99355 now apply to prolonged face-to-face outpatient psychotherapy as well as to prolonged face-to-face E/M codes. Use a primary E/M or psychotherapy code, one 99354 (30-74 minutes in addition to the time spent on the initial/primary service) per day and as many units of 99355 as needed to match the time spent.

Note: Some insurance do not pay for these codes.  You may need to request for insurance to add them to your fee schedule or bill patients. The above guidelines apply to outpatient services only and these add-on codes must be reported with a primary code.

TIP: Document what you did and how long you did it. If you are reporting additional procedures, document the time and note that they are excluded from the prolonged service.

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