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
