decisionhealth Newsletters, Answer Books - 2011 Issue 5 (May)
Prolonged Services / How much time do you need Threshold times
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Article Overview
This article reviews Medicare threshold timing guidance for prolonged services associated with office, outpatient, consultation, inpatient, and certain facility-based E/M codes. It is intended for coders and billing staff who need to understand where the timing tables come from, which code families are included, and how the threshold charts are organized in the Medicare Claims Processing Manual.
Why This Topic Matters
Prolonged services are time-sensitive and payer-specific, so understanding the applicable threshold tables helps coding and billing teams review visit time against Medicare guidance and the CPT framework.
Article Sections
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Threshold Time for Prolonged Visit Codes 99354 and/or 99355 Billed with Office/Outpatient and Consultation Codes
This section presents Medicare threshold timing information for prolonged services paired with office, outpatient, and consultation E/M code families.
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Threshold Time for Prolonged Visit Codes 99356 and/or 99357 Billed with Inpatient Setting Codes
This section presents Medicare threshold timing information for prolonged services paired with inpatient and related facility E/M code families.
What You Will Learn
- How Medicare frames threshold timing for prolonged services
- Which E/M code families are grouped with prolonged service timing tables
- How the article organizes office/outpatient and inpatient prolonged service guidance
- Where the guidance is sourced within the Medicare Claims Processing Manual
Who Should Read This
- Medical coders
- Billing specialists
- Compliance staff
- Revenue cycle professionals
- Physician practice managers
Codes Discussed
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