Transmittals: Physicians Can Bill For Prolonged E/M In Nursing Facilities

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers a CMS transmittal addressing prolonged evaluation and management billing for nursing facility and skilled nursing facility visits. It is useful for physicians, coders, and billing staff who work with nursing facility E/M services, CPT time references, and Medicare guidance. The discussion focuses on the policy update, the affected service categories, and the general billing context surrounding prolonged services.

Why This Topic Matters

The article is relevant because it clarifies whether prolonged time spent during nursing facility E/M visits may be reported under Medicare guidance, which affects physician billing and documentation workflows.

What You Will Learn

  • How CMS guidance relates to prolonged evaluation and management services in nursing facilities
  • Which broad nursing facility service categories are addressed in the update
  • How CPT time references factor into prolonged service reporting
  • Why Medicare transmittal guidance matters for billing in skilled nursing and nursing facilities

Who Should Read This

  • Physicians
  • Medical coders
  • Billing staff
  • Practice managers
  • Compliance professionals

Codes Discussed

  • CPT: 99356
  • CPT: 99357
  • CPT: 99354

Code Ranges Discussed

  • CPT: 99304-99310
  • CPT: 99318

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