How To Use CPT Code 99356 - Updated 2025 - Coding Ahead CPT code 99356 is used when a provider has spent additional time on an inpatient or observation evaluation and management service, specifically for the first hour of prolonged service It is essential to report this code in conjunction with an appropriate primary E M code to ensure reimbursement
Code and Guideline Changes | AMA - American Medical Association Prolonged Services (99354, 99355, 99356, 99417) Code and Guideline Changes This document includes the following CPT E M changes, effective January 1, 2021: • E M Introductory Guidelines related to Office or Other Outpatient Codes 99202-99215 • Revised Office or Other Outpatient E M codes 99202-99215
Prolonged service codes 99354, 99355, 99356, 99357, 99358 and 99359 . . . 99356 - The first prolonged period, greater than 30 minutes and up to one hour, in an inpatient hospital setting 99357 - The additional 30-minute period after the 99356 99358 - This non face-to-face prolonged service code (the first 30 - 60 minutes) must be used before or after an evaluation and management visit, and is not an add-on code
Changes to Coding for Prolonged Services in 2023 Depending on their setting, providers can use these new codes in lieu of CPT codes 99356 (Prolonged service in the inpatient or observation setting), and 99357 (Prolonged service in the inpatient or observation setting)
Extend Prolonged Service Smarts With New Codes : E M 2023 - AAPC For 2023, CPT® also deletes prolonged service codes +99354 and +99355 In their place, you’ll now use +99417, as CPT® has increased its scope You’ll now be allowed to use it to report prolonged services with: Add This New CPT® Prolonged Service Code
CMS Manual System - Centers for Medicare Medicaid Services Therefore, medically necessary prolonged services for E M visits and medically necessary time-based visits for counseling and or coordination of care for Nursing Facility Services may be billed with the appropriate prolonged services codes (99356 and 99357)
The right way(s) to bill for prolonged care - Todays Hospitalist You would not be able to report an inpatient prolonged care code 99356 (prolonged service in the inpatient or observation setting, face-to-face time with the patient, first hour) until the total time for the encounter hits 55 minutes
Hard Facts of Coding Prolonged Services - AAPC Prolonged service codes 99354-99357 are used when a physician or other qualified health provider performs a prolonged service involving direct (face-to-face) patient contact that goes beyond the usual service in either the inpatient or outpatient (office, clinic, observation, etc ) setting
Billing Prolonged Services with Direct Patient Contact There are four codes to choose from when billing for prolonged services with direct patient contact They are based on whether the patient is in the office outpatient setting, or if the patient is in an inpatient observation setting Report 99354 in addition to E M codes 99201-99215, 99241-99245, 99324-99337, 99341-99350
(2023) How To Code Prolonged Services (CPT 99354 - Coding Ahead Description of CPT 99356: Prolonged physician service in the inpatient setting, requiring unit floor time beyond the usual service; first hour CPT 99356 can be reported along with CPT codes 90822, CPT 90829, CPT 99221 – CPT 99233, CPT 99251 – CPT 99255 and CPT 99304 – CPT 99310)