CPT codes changes 2021 for Prolonged Services Code and Guideline Changes


Prolonged Service With Direct Patient Contact 

Codes 99354-99357 are used when a physician or other qualified health care professional provides a prolonged service involving direct patient contact that goes above and beyond the usual service in an inpatient, observation, or outpatient setting, except when office or other outpatient services are provided (99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215). Face-to-face patient contact includes additional non-face-to-face services provided on the patient's floor or unit in the hospital or nursing facility during the same session. In addition to the primary procedure, this service is reported. Appropriate codes should be chosen for supplies provided or other procedures performed in the patient's care during this time frame.

Codes 99354-99355 are used to report the total duration of face-to-face time spent by a physician or other qualified health care professional on a given date providing prolonged service in the outpatient setting, even if that time is not continuous. Codes 99356-99357 are used to report the total duration of time spent by a physician or other qualified health care professional at the bedside and on the patient’s floor or unit in the hospital or nursing facility on a given date providing prolonged service to a patient, even if the time spent by the physician or other qualified health care professional on that date is not continuous. 




Time spent performing separately reported services other than E/M or psychotherapy is not included in the time allotted for prolonged services. Depending on the location of service, code 99354 or 99356 is used to report the first hour of prolonged service on a given date. Even if the time spent by the physician or other qualified health care professional is not continuous on that date, either code should be used only once per date. Prolonged service lasting less than 30 minutes on a given date is not separately reported.
Code 99355 or 99357 is used to report each additional 30 minutes beyond the first hour, depending on the place of service. 

Either code can be used to report the last 15-30 minutes of extended service on a specific date. Prolonged service of less than 15 minutes after the first hour or less than 15 minutes after the final 30 minutes is not separately reported. The primary evaluation and management service must have a typical or specified time published in the CPT codebook in order to use the time-based add-on codes.

99354 

Prolonged service in the outpatient setting requiring direct patient contact beyond the time of the usual service; first hour (List separately in addition to code for outpatient Evaluation and Management or psychotherapy service, except with office or other outpatient services [99202-99215]) (Use 99354 in conjunction with 90837, 90847, 99241-99245, 99324-99337, 99341-99350, 99483) (Do not report 99354 in conjunction with 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99415, 99416, 99417) 

99355 

Each additional 30 minutes (List separately in addition to code for prolonged service) (Use 99355 in conjunction with 99354) (Do not report 99355 in conjunction with 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99415, 99416, 99417) 

99356 

Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient or observation Evaluation and Management service) (Use 99356 in conjunction with 90837, 90847, 99218-99220, 99221-99223, 99224-99226, 99231-99233, 99234-99236, 99251-99255, 99304-99310) 

99357

Each additional 30 minutes (List separately in addition to code for prolonged service) (Use 99357 in conjunction with 99356).

Prolonged Service Without Direct Patient Contact 


When a prolonged service is provided that is neither face-to-face time in an outpatient, inpatient, or observation setting, nor additional unit/floor time in a hospital or nursing facility setting, codes 99358 and 99359 are used. Except for office or other outpatient services, codes 99358, 99359 may be used during the same session of an evaluation and management service (99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215). Use 99417 for extended periods of time without direct patient contact on the date of office or other outpatient services. Codes 99358, 99359 can also be used for extended services performed on a date other than the date of a face-to-face encounter.

This service must be reported in conjunction with other physician or qualified health care professional services, including evaluation and management at any level. This extended service may be reported on a different date than the primary service it is associated with. Extensive record review, for example, could be related to a previous evaluation and management service performed at a previous date. It must, however, be related to a service or patient in which (face-to-face) patient care has occurred or will occur, as well as ongoing patient management.

Codes 99358 and 99359 are used to report the total duration of non-face-to-face time spent by a physician or other qualified health care professional on a given date providing prolonged service, even if that time is not continuous. Code 99358 is used to report the first hour of extended service on a given date, regardless of location. It should only be used once per date.

Prolonged service lasting less than 30 minutes on a given date is not separately reported.

Code 99359 is used to report every 30 minutes after the first hour. It can also be used to report the last 15 to 30 minutes of extended service on a specific date.

Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately. Do not report 99358, 99359 for time without direct patient contact reported in other services such as care plan oversight services (99339, 99340, 99374-99380), chronic care management by a physician or other qualified health care professional (99491), home and outpatient INR monitoring (93792, 93793), medical team conferences (99366-99368), interprofessional telephone/internet/electronic health record consultations (99446-99452), or on-line digital evaluation and management services (9X0X1, 9X0X2, 9X0X3). 

99358 

Prolonged evaluation and management service before and/or after direct patient care; first hour 

99359 

Each additional 30 minutes (List separately in addition to code for prolonged service) (Use 99359 in conjunction with 99358) (Do not report 99358, 99359 on the same date of service as 99417) (Do not report 99358, 99359 during the same month with 99484, 99487-99489, 99490, 99491, 99492, 99493, 99494) (Do not report 99358, 99359 when performed during the service time of codes 99495 or 99496, if reporting 99495 or 99496

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