Office or Outpatient Care Prolonged Services: Description and Companion Codes

Published 11/02/2017

Prolonged services may be billed for direct, face-to-face outpatient services. The service must be on the same day of service as the primary service and performed by the same provider. The CPT code 99354 is for prolonged service, office or outpatient, first hour. After the first hour, submit CPT code 99355 for each additional 30 minutes.

In determining whether prolonged services can be billed and to determine the prolonged services codes that are allowable, you may count only the duration of direct face-to-face contact with the patient which is beyond the typical/average time of the visit code billed (whether the service was continuous or not).

In the outpatient or office setting, time spent by office staff with the patient, or times the patient remains unaccompanied in the office cannot be used to determine the time of prolonged services.

These codes require submission of an outpatient evaluation and management code as a companion code. Documentation for prolonged services must contain enough information to substantiate the medical necessity of the prolonged service and the start and end times of the visit must be documented.

Prolonged Outpatient E/M Codes

CPT Code
Description
Time of Code
Companion Codes Required
99354
Prolonged outpatient E/M, face-to face, beyond typical time, first hour
First hour; 30-74 minutes
an outpatient E/M code
99355
Prolonged outpatient E/M, face-to face, beyond typical time, each additional 30 minutes
Each added
30 minutes; bill after 75 minutes or more
an outpatient E/M code
and the 99354, first hour code

Tables below include descriptors of companion codes that may be submitted as pre-requisites for billing office or outpatient prolonged services.

New Patient Office/Outpatient Codes (CPT Codes 99201-99205)

Companion CPT Code
Level of Severity
Typical Time Spent
Required  Key Components
99201
self-limited or minor
10 minutes
History- Problem focused
Exam- Problem focused
Medical decision making-Straightforward
99202
low to moderate
20 minutes
History- Expanded problem focused
Exam- Expanded problem focused
Medical decision making-Straightforward
99203
moderate
30 minutes
History- Detailed
Exam- Detailed
Medical decision making-Low-complexity
99204
moderate to high
45 minutes
History- Comprehensive
Exam- Comprehensive
Medical decision making-Moderate
99205
moderate to high
60 minutes
History- Comprehensive
Exam- Comprehensive
Medical decision making-High complexity

Established Patient Office/Outpatient (CPT Codes 99212-99215)

Companion CPT Code
Level of Severity
Typical Time Spent
Requires 2 of 3 Key Components
99212
self-limited or minor
10 minutes
History- Problem focused
Exam- Problem focused
Medical decision making-Straightforward
99213
low to moderate
15minutes
History- Expanded problem focused
Exam- Expanded problem focused
Medical decision making- Low
complexity
99214
moderate to high
25 minutes
History- Detailed
Exam- Detailed
Medical decision making- Moderate complexity
99215
moderate to high
40 minutes
History- Comprehensive
Exam- Comprehensive
Medical decision making- High complexity

Domiciliary, Rest Home, or Custodial Care Services- New Patient (CPT Codes 99324-99328)

Companion CPT Code
Level of Severity
Typical Time Spent
Required Key Components
99324
low
20 minutes
History- Problem focused
Exam- Problem focused
Medical decision making-Straightforward
99325
moderate
30minutes
History- Expanded problem focused
Exam- Problem focused
Medical decision making- Low complexity
99326
moderate to high
45 minutes
History- Detailed
Exam- Detailed
Medical decision making- Moderate complexity
99327
high
60 minutes
History- Comprehensive
Exam- Comprehensive
Medical decision making-Moderate
99328
high
75 minutes
History- Comprehensive
Exam- Comprehensive
Medical decision making-Moderate

Domiciliary, Rest Home, or Custodial Care Services- Established Patient (CPT Codes 99334-99337)

Companion CPT Code
Level of Severity
Typical Time Spent
Requires 2 of  3Key Components
99334
self-limited or minor
15 minutes
History- Problem focused interval
Exam- Problem focused
Medical decision making-Straightforward
99335
low to moderate
25 minutes
History- Expanded problem focused interval
Exam- Expanded problem focused
Medical decision making- Low complexity
99336
moderate to high
40 minutes
History- Detailed interval
Exam- Detailed
Medical decision making- Moderate complexity
99337
moderate to high
 60 minutes
History- Comprehensive interval
Exam- Comprehensive
Medical decision making- High complexity

Home services- New Patient (CPT Codes 99341-99345)

Companion CPT Code
Level of Severity
Typical Time Spent
Required 3 Key Components
99341
low
20 minutes
History- Problem focused 
Exam- Problem focused
Medical decision making-Straightforward
99342
moderate
30 minutes
History- Expanded problem focused
Exam- Expanded problem focused
Medical decision making- Low complexity
99343
moderate to high
45 minutes
History- Detailed
Exam- Detailed
Medical decision making- Moderate complexity
99344
high
60 minutes
History- Comprehensive
Exam- Comprehensive
Medical decision making- Moderate complexity
99345
Requires immediate physician attention
75 minutes
History- Comprehensive
Exam- Comprehensive
Medical decision making- High complexity

Home Services- Established Patient (CPT Codes 99347-99350)

Companion CPT Code
Level of Severity
Typical Time Spent
Required 3 Key Components
99347
self-limited or minor
15 minutes
History- Problem focused  interval
Exam- Problem focused
Medical decision making-Straightforward
99348
low to moderate
25 minutes
History- Expanded problem focused interval
Exam- Expanded problem focused
Medical decision making- Low complexity
99349
moderate to high
40 minutes
History- Detailed interval
Exam- Detailed
Medical decision making- Moderate complexity
99350
Requires immediate physician attention
60 minutes
History- Comprehensive interval
Exam- Comprehensive
Medical decision making- Moderate to High complexity

References