CPT® Code 99417 is used to report prolonged evaluation and management (E/M) services provided in an outpatient setting—when a physician or qualified healthcare provider spends additional time beyond the typical requirements of a high-level visit. Specifically, it applies when time spent with a patient exceeds the full duration of CPT 99205 (new patient) or 99215 (established patient) by at least 15 minutes.
This code reflects the extra time invested in complex, high-need visits that require extended counseling, coordination of care, in-depth documentation, or patient education. It is an add-on code and cannot be used alone—it must accompany a time-based level 5 E/M service and is billed in 15-minute increments.
Key facts about CPT Code 99417
Service type: Prolonged evaluation and management (E/M)
Provider type: Physicians and qualified healthcare professionals
Medical services included: Yes—this is a continuation of a full medical E/M visit
Typical duration: First unit begins after 15 minutes beyond 99205 or 99215
Common uses:
- Chronic condition management requiring extended patient education
- Complex intake or re-evaluation visits
- Coordinating multi-specialty treatment plans
- End-of-life or behavioral health care with layered concerns
When to use CPT Code 99417
CPT 99417 is appropriate when a provider has already met the time threshold for a level 5 outpatient visit and continues to deliver direct patient care or related services on the same day. The work must involve medically necessary services such as in-depth history-taking, counseling, coordination with other providers, or extensive documentation performed during or immediately after the encounter.
This code is only used when the primary E/M visit (99205 or 99215) is selected based on time, not medical decision-making. For Medicare patients, G2212 should be used instead due to CMS-specific guidelines.
Documentation requirements
To support the use of CPT 99417, documentation should clearly reflect:
- Total face-to-face and non-face-to-face time spent on the visit
- Description of the services performed during the extended time
- Clinical justification for the prolonged encounter
- Confirmation that time exceeded the threshold for 99205 or 99215
- A time log or notation of start/stop times (if required by payer)
Documentation should also note that the visit was selected based on total time, not complexity or medical decision-making alone.
Reimbursement and coding considerations
CPT 99417 is covered by many commercial insurers and some Medicaid programs, but it is not accepted by Medicare, which uses G2212 instead. Most payers require documentation that clearly supports the extra time and prohibits billing of other time-based services on the same date.
Important considerations:
- Only report in conjunction with 99205 or 99215 (time-based)
- Time must exceed 15 minutes beyond the typical threshold to report the first unit
- Some payers may limit how often 99417 can be billed for a single patient
- Check payer policies regarding modifiers or prior authorization
How OptiMantra supports time-based billing
For integrative, functional, and specialty practices where extended visits are the norm—not the exception—OptiMantra makes it easy to track, document, and bill for prolonged services like CPT 99417 with accuracy and efficiency.
With OptiMantra, providers can:
- Automatically log clinical time spent during and after patient visits
- Use E/M templates that include time-based coding logic
- Document prolonged services directly in the chart, aligned with payer requirements
- Generate clean, audit-ready notes that support CPT 99417 or G2212
- Link time-tracked encounters with billing workflows for streamlined claims
Whether you're managing a complex chronic condition, delivering whole-person care, or simply spending the extra time your patients deserve, OptiMantra helps you get properly reimbursed—without adding to your documentation burden.
Try OptiMantra for free here!
