Note: CPT® code 99355 was officially deleted as of 2023, and is no longer valid for reporting.
What Was CPT 99355?
CPT® Code 99355 was used to report each additional 30 minutes of prolonged service provided in the office or outpatient setting with direct patient contact, beyond the time of the primary evaluation and management (E/M) service. It was an add-on code and used in conjunction with the appropriate primary prolonged service code (e.g., 99354, when applicable under payer guidelines).
This code reflected extended, medically necessary time spent managing complex patient needs that go beyond typical visit durations.
Key Facts About CPT® 99355
- Service type: Add-on E/M (prolonged services)
- Time requirement: Each additional 30 minutes beyond the initial prolonged service
- Setting: Office or outpatient
- Contact type: Direct face-to-face patient contact
- Used with: Primary prolonged service code (e.g., 99354, when recognized by payer)
Common clinical indications:
- Complex patient encounters requiring extended evaluation and management
- Multiple chronic conditions requiring in-depth coordination and decision-making
- Detailed counseling or care planning beyond standard visit time
- Extended visits for medically complex or unstable patients
When CPT® 99355 was Used
CPT 99355 was appropriate when:
- Prolonged services exceeded the time reported with the primary E/M service
- The provider had already met criteria for the initial prolonged service code
- Each additional 30-minute increment of direct patient contact was documented
- The extended time was medically necessary and not routine
Examples:
- Spending an additional 60 minutes managing a complex patient after the base E/M and first prolonged service are completed
- Extended counseling and coordination for a patient with multiple comorbidities
- Complex care discussions requiring significantly more time than typical visits
- In-depth management of a patient with rapidly changing clinical status
Documentation Requirements
To support CPT 99355 billing, documentation should include:
- Patient identifiers and date of service
- Primary E/M service code billed
- Total face-to-face time spent with the patient
- Clear breakdown of prolonged service time beyond the base service
- Description of services provided during extended time
- Medical necessity for prolonged services
- Provider signature and credentials
Precise time tracking and detailed documentation are essential for compliance.
Reimbursement and Coding Considerations
- CPT 99355 was an add-on code and cannot be billed alone
- Was used with a qualifying primary E/M or prolonged service code
- Time was face-to-face and exceeded thresholds for base and initial prolonged services
- Has been replaced with newer prolonged service codes (e.g., 99417, G2212)
- Documentation clearly justified extended time and medical necessity
- Payer policies and coverage vary significantly
Always verify payer-specific guidelines for prolonged services coding.
How OptiMantra Supports Prolonged Service Billing
OptiMantra’s integrated EMR and practice management system simplifies documentation and billing:
With OptiMantra, providers can:
- Track and document total visit time to support prolonged service coding and documentation workflows
- Document extended care activities within customizable E/M templates
- Maintain organized clinical documentation, including time-based documentation, that supports compliance and audit preparedness
- Support coding workflows by documenting visit time, complexity, and clinical services provided
- Streamline workflows for longer, complex patient encounters
By enabling precise time tracking and documentation, OptiMantra helps practices ensure compliance and optimize reimbursement for prolonged services.
Try OptiMantra for free here!
Disclaimer: CPT® codes are maintained by the American Medical Association. This guide is for informational purposes only and does not replace official coding guidelines or payer policies.
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