Extended Time Spent on Direct Patient Care Beyond Typical Evaluation and Management
CPT® code 99354 is used to report prolonged evaluation and management (E/M) services provided by a physician or other qualified healthcare professional in the office or outpatient setting, requiring direct patient contact that extends at least 30 minutes beyond the typical time of the primary E/M service. This code captures medically necessary, face-to-face time spent addressing complex cases requiring additional evaluation, counseling, coordination, or treatment planning.
When to Use CPT® Code 99354
Report 99354 when:
- A provider spends an additional 30–74 minutes beyond the typical time associated with the primary E/M service (e.g., 99205 or 99215).
- The extra time involves direct, face-to-face patient care.
- The encounter requires significant additional effort due to the patient’s complexity or medical decision-making needs.
- Documentation clearly supports that the service exceeded standard duration and was medically necessary.
If the prolonged service extends beyond 74 minutes, CPT® code 99355 should also be reported for each additional 30 minutes.
Documentation Requirements
Thorough documentation is essential to justify prolonged service billing, including:
- Start and end times of the total face-to-face encounter
- Detailed description of the additional care provided (e.g., extended counseling, coordination, review of multiple comorbidities)
- The reason prolonged time was medically necessary
- Reference to the primary E/M service code billed for the encounter
- Provider credentials and signature
Include all relevant clinical notes supporting that the additional time was spent directly with the patient, not on separate administrative tasks.
Billing Guidelines
- 99354 is an add-on code and must be used in conjunction with an appropriate E/M service (99205, 99215, etc.).
- It may not be reported for time spent on separately billable services (e.g., psychotherapy, procedures).
- The service must involve face-to-face time in the office or outpatient setting; non-face-to-face activities (e.g., record review) do not qualify.
- Each payer may have specific time thresholds and documentation requirements—always verify prior to billing.
- Only one unit of 99354 may be reported per encounter for the first hour of extended time.
Example
A provider conducts a 40-minute follow-up visit for a patient with multiple chronic conditions, then spends an additional 50 minutes counseling the patient and coordinating care with other specialists. The encounter exceeds the typical time for CPT® 99215 by over 30 minutes. The provider bills 99215 for the primary E/M service and 99354 for the first hour of prolonged service, supported by detailed time logs and documentation.
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Accurate time tracking is crucial when reporting prolonged services. OptiMantra streamlines this process by automatically capturing session durations, linking them to corresponding E/M codes, and generating compliant billing documentation. With customizable templates and integrated charting, providers can ensure every minute of patient care is documented, justified, and reimbursed—without additional administrative effort.
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