New coding guidance: CMS creates 3 new prolonged codes, won’t assign frequency limits

Why This Topic Matters

The guidance can affect how time-based E/M services are reported, documented, and reimbursed under Medicare. Understanding the CMS changes helps practices align coding workflows with setting-specific prolonged service policies and avoid mismatches with payer expectations.

Article Sections

1. Overview of the new prolonged service codes

   Introduces the 2023 CMS changes affecting prolonged service reporting and explains the broader context for time-based E/M billing across different care settings.

2. CMS policy details and code framework

   Discusses CMS’s finalized approach to prolonged service reporting, including how the new HCPCS codes are positioned relative to related E/M services and time-based requirements.

3. CMS makes its own time

   Summarizes CMS’s rationale for creating Medicare-specific prolonged service policy and its stated position on the timing framework used for these services.

4. CMS delivers 4 more surprises

   Covers additional final-rule changes affecting reporting flexibility, frequency limitations, cognitive assessment services, and telehealth treatment of prolonged service codes.