CMS diverges from CPT guidance on time rules for new prolonged code

Why This Topic Matters

The article matters because changes in time-based reporting can affect how office/outpatient E/M claims are documented and submitted. Readers need to understand the policy difference between CMS and AMA guidance to avoid inconsistent billing practices and to stay aligned with 2021 Medicare proposals.

Article Sections

1. CMS and AMA timing guidance for prolonged services

   Introduces the policy issue and the differing time-based approaches discussed for office/outpatient E/M services and prolonged services.

2. Comparison of proposed time thresholds

   Presents a side-by-side comparison of proposed reporting thresholds for the relevant office visit levels and the prolonged service code under two guidance approaches.

3. Source references

   Lists the cited guideline and fee schedule sources supporting the discussion.