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29.2.18.6 Prolonged Physician Services
Prolonged services (procedure codes 99354, 99355, 99356, and 99357) may be provided in an office, outpatient, or inpatient setting and involves direct (face-to-face) client contact that is beyond the usual service and exceeds the time threshold of the E/M procedure code (listed in the table below) being billed on that day:
Procedure codes 99354 and 99356 should be used in conjunction with the E/M code to report the first hour of prolonged service and are limited to one per day.
Procedure codes 99355 and 99357 should be used to report each additional 30 minutes and are limited to a quantity of 3 units or 1 ½ hours per day.
Prolonged services of less than 30 minutes duration should not be reported separately.
Prolonged services in the inpatient setting may be considered for reimbursement on the same day as an initial hospital visit (procedure codes 99221, 99222, 99223, 99251, 99252, 99253, 99254, or 99255) or a subsequent hospital visit (procedure codes 99231, 99232, 99233, 99251, 99252, 99253, 99254, or 99255).
Prolonged physician services are not reimbursed in addition to critical care and/or emergency room visits billed on the same day.
Procedure code 99360 is not a benefit of the CSHCN Services Program.
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