CMS vs CPT®: Confront Agency Differences for Reporting Prolonged Services

Why This Topic Matters

Prolonged services reporting changed in 2023, and the rules are not aligned between CPT® and Medicare. Understanding the update helps readers follow the correct code set and keep evaluation and management reporting current.

Article Sections

1. Learn These CPT® 2023 Updates

   Summarizes the CPT® 2023 changes affecting prolonged services within evaluation and management coding. The section covers the general nature of the revisions, deletions, and additions discussed in the article.

2. See How Medicare Judges Prolonged Service

   Explains the Medicare perspective on prolonged services and how CMS addresses these services differently from CPT®. The section also introduces the related HCPCS Level II updates and the broader CMS framework.

3. CMS 2023

   Describes the CMS 2023 Medicare Physician Fee Schedule updates related to prolonged services. The section focuses on the policy context and the categories of HCPCS Level II reporting changes.

4. Consultation

   Notes the article’s discussion of Medicare’s position on consultation reporting and its relationship to prolonged-service G codes. This section provides additional context on what Medicare does and does not support.