This post includes:
- CPT® rules for prolonged care non face-to-face
Codes 99358 and 99359 are used for non-face-to-face prolonged services by the billing physician/NP/PA when provided in relation to an E/M service on the same or different day as an E/M service.
Beginning in 2021, you may not report these services on the same day as codes 99202-99215, office visit codes. And, starting 1/1/2023, CMS has given these codes a status indicator of invalid, meaning they won’t pay for them. They are still active CPT® codes. Individual payers will make their own reimbursement determinations.
|99358||Prolonged evaluation and management service before and/or after direct patient care, first hour|
|99359||each additional 30 minutes (List separately in addition to code for prolonged services)|
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Using 99358 for phone calls
Can a physician/NP/PA use non-face-to-face prolonged services codes 99358, 99359 for telephone calls?
My answer to this question has always been a qualified no. I based my opinion on the examples given by both CMS (in their Final Rule) and CPT® (in the CPT Changes: 2010 An Insider’s View) during the year these codes were developed and recognized. And, the fact that there are telephone codes in CPT. Before the pandemic the phone codes had a status indicator of noncovered, and CMS intends to assign that status indicator to those codes after the pandemic ends.
The CPT Assistant answered this question in their September 2021 issue. The question they posed is this one. If a physician/NP/PA initiates a phone call with a patient on a different day than an E/M service, and the telephone call takes at least 30 minutes, can the practitioner use 99358 when a related E/M service has not occurred on that day? Notices my emphasis on initiates, because it makes a difference in the answer to this question.
Their answer is yes, with several caveats.
- The telephone call must relate to a face-to-face service that has occurred or will occur
- It must relate to ongoing patient management
And, a few reminders:
- Beginning in 2021, 99358 may not be reported on the same day as an office visit code 99202—99215
- These codes are for the work of a physician or qualified health care professional who has E/M in their scope of practice, not clinical staff
The article goes on to say that if this was a patient-initiated call then use codes 99441—99443. The article continues ““[t]hese codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient” (p 49). Therefore, codes 99441–99443 would not be reported for a telephone discussion initiated by a physician or other QHP.”
The AMA has added their own caveat at the end of this Q&A. “Note that third-party payer guidelines may differ from CPT coding guidelines, as both coverage and payment policy are determined by individual insurers or third-party payers. For reimbursement or third-party payer policy issues, contact the appropriate payer.”
99358 Prolonged evaluation and management service before and/or after direct patient care; first hour
99359 each additional 30 minutes
99441 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
99442 11-20 minutes of medical discussion
99443 21-30 minutes of medical discussion
 CPT Assistant, Sept. 2021. The American Medical Association.
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