For Medicare, medical necessity is the overarching criteria, in addition to component scoring, used to determine the level of E/M service. associate partner at Pinnacle Enterprise Risk Consulting Services, Charlotte, North Carolina. If, however, the patient's condition and the documentation supports a level five (99205 or 99215) level of service, and exceeds the upper limit of the time range, then HCPCS code G2212 would be reported. HCPCS code G2212 is as follows, "Prolonged office or other outpatient evaluation and management service (s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct 354 0 obj <>/Filter/FlateDecode/ID[<91A2005DF854F64E856D6A7174D11ED9>]/Index[327 45]/Info 326 0 R/Length 121/Prev 260514/Root 328 0 R/Size 372/Type/XRef/W[1 3 1]>>stream The source of this chart is CMSs 2023 Final Rule. To avoid potential confusion with CPT guidelines, CMS created a new prolonged service code, recognized by Medicare and payers following Medicare payment rules, to take its place: G2212 (Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact ). Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99306, 99310 for nursing facility evaluation and management services). CMS is allowing time on days prior to and after the date of the encounter to be used for prolonged services in relation to home/residence visits. PDF Prolonged Services Policy, Professional - UHCprovider.com Do not report G0316 for any time unit less than 15 minutes. G0318 (Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service each additional 15 minutes ) for prolonged home or residence E/M service codes 99345 and 99350 CMSs manual does not currently require start and stop times. Coding for prolonged services: CPT and HCPCS codes - CodingIntel PDF 2021 & 2023 Updates to Evaluation and Management (E/M) Visits and CMS does not recognize consult codes. How To Properly Report Prolonged Services Using 99417 or G2212 Practitioners should not report prolonged office/outpatient E/M visit time using CPT codes 99354 and 99355 (Prolonged service with direct patient contact), 99358 and 99359 (Prolonged service without direct patient contact), 99415 and 99416 (Prolonged clinical staff services), or 99417 (Prolonged office/outpatient E/M services with or without direct patient contact), HCPCS code G2212 (Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (List separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services).
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