Prolonged Services are to be used when the level of service is based on time and the time for the highest level of service (99205 or 99215) has been exceeded. Time includes both face-to-face activities and non-face-to-face activities when performed on the same calendar date as the office visit.
The AMA and Medicare differ when it comes to calculating time for prolonged services. Please refer to the tables below when adding prolonged services to your outpatient codes 99205 and 99215. Medicare uses G2212 for prolonged services. Epic will automatically convert to this code when you enter code 99417. Please find a provider's tip sheet here. The coders will add prolonged services for Inpatient services.
| Commercial and Medicaid Payors | |
|---|---|
| Prolonged Services - AMA (Commercial and Medicaid) | |
| Codes | New PT - Total Duration |
| 99205 | 60-74 minutes |
| 99205 x 1 and 99417 x 1 | 75-89 minutes |
| 99205 x 1 and 99417 x 2 | 90-104 minutes |
| 99205 x 1 and 99417 x 3 or more for each additional 15 minutes | 105 or more minutes |
| Codes | New PT - Total Duration |
| 99215 | 40-54 minutes |
| 99215 x 1 and 99417 x 1 | 55-69 minutes |
| 99215 x 1 and 99417 x 2 | 70-84 minutes |
| 99215 x 1 and 99417 x 3 or more for each additional 15 minutes | 85 minutes or more |
| All Medicare and Medicare Managed Care Only | |
|---|---|
| Prolonged Services - Medicare and Medicare Managed Care | |
| Codes | New PT - Total Duration |
| 99205 | 60-74 minutes |
| 99205 x 1 and 99417 x 1 | 89-103 minutes |
| 99205 x 1 and 99417 x 2 | 104-118 minutes |
| Codes | Est Pt - Total Duration |
| 99215 | 40-54 minutes |
| 99215 x 1 and 99417 x 1 | 69-83 minutes |
| 99215 x 1 and 99417 x 2 | 84-98 minutes |
| 99215 x 1 and 99417 x 3 or more for each additional 15 minutes | 99 or more minutes |
| Epic will convert 99417 to G2212 | |