CMS creates 3 new prolonged codes, won’t assign frequency limits

Why This Topic Matters

These CMS changes affect how time-based E/M services and prolonged add-on services are reported and paid in Medicare settings. The article helps readers understand the scope of the new guidance, the affected code families, and the broader policy context for 2023.

Article Sections

1. New prolonged service codes and setting-based reporting

   Introduces the new HCPCS prolonged service codes and explains the broad care settings and E/M service categories they relate to.

2. CMS policy rationale and time-based reporting context

   Summarizes CMS’s position on prolonged service reporting, including its Medicare-specific approach and the role of time in the underlying E/M service.

3. Additional CMS changes affecting prolonged services

   Covers other final-rule changes, including reporting context across dates of service, frequency-related policy, and telehealth-related placement.

4. Prolonged service threshold chart

   Describes the accompanying reference chart that maps primary E/M services to add-on prolonged service reporting and timing information.