Three examples to help you bill prolonged services

Why This Topic Matters

Prolonged services coding can be difficult when visit time, counseling, coordination of care, and face-to-face contact do not align neatly with documentation. This article helps readers understand the scope of the CMS update and the kinds of scenarios that may affect how prolonged time is reported in Medicare claims.

Article Sections

1. CMS clarification and manual update

   Introduces a CMS transmittal and summarizes the broader Medicare claims processing updates tied to prolonged services and visit-time reporting.

2. Key considerations for counting prolonged service time

   Reviews general time-counting considerations for prolonged services, including differences between office and inpatient settings and the role of counseling or coordination of care.

3. Examples of prolonged services billing

   Presents several office-visit scenarios that illustrate how prolonged services are discussed in relation to established patient encounters and longer evaluation and management visits.

4. Non-billable prolonged service categories for Medicare

   Notes the Medicare coverage status of prolonged services performed without face-to-face contact and identifies the related categories discussed in the article.