DecisionHealth, DecisionHealth - 2011 Issue 5 (May)

Prolonged Services / How much time do you need Threshold times

You know you can use prolonged service codes with visits and consults if they exceed the typical time for the service by 30 minutes or more. CMS’s “typical times” for E/M procedures conform to those in the CPT. The Medicare Claims Processing Manual, Chapter 12, Section 30.6.15, includes charts that list the threshold time needed to bill office/outpatient (with direct patient contact) codes 99354 (first hour) and 99355 (each additional 30 minutes), as well as inpatient codes 99356 (first hour) and 99357 (each additional 30 minutes).

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