2025 CPT code 99359
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Prolonged Services Feed
Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes (List separately in addition to code for prolonged service)
Modifiers may be applicable depending on the specific circumstances. For example, modifier 25 may be used to indicate a significant, separately identifiable E/M service on the same day as the prolonged service if appropriate.
The prolonged service must be medically necessary and directly related to the patient's evaluation and management.It must represent time spent beyond the usual service on activities that are clinically appropriate and required for the patient's care.
The physician or other qualified healthcare professional performs and documents prolonged services related to the patient's care that require additional time beyond the typical face-to-face encounter. This may include reviewing extensive records, communicating with other professionals, or coordinating care with family/caregivers.
In simple words: This code is used when a doctor spends extra time, beyond the usual visit, caring for a patient indirectly, such as reviewing records or consulting with other professionals, on a date different from the actual face-to-face appointment. It's billed in 30-minute increments after the first hour of this extra time.
Prolonged evaluation and management service before and/or after direct (face-to-face) patient care; each additional 30 minutes (List separately in addition to code for prolonged service). This code is used to report each additional 30 minutes of prolonged service beyond the first hour, on a date other than the date of the face-to-face E/M service. It may also be used to report the final 15 to 30 minutes of such prolonged service.Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately.
Example 1: A physician spends an additional 1 hour and 45 minutes on a day other than the patient visit reviewing complex medical history, lab results, and imaging studies to formulate a treatment plan for a new patient with a complicated condition. 99358 would be billed for the first hour, and 99359 would be billed once for the additional 45 minutes., A physician spends 30 minutes on the phone with a patient's family members on a day other than the patient visit, discussing treatment options and coordinating care. This would not be billable as it is less than the required additional 30 minutes beyond the first prolonged hour reported with 99358., A physician receives a call from a patient on Sunday with complaints of worsening symptoms. On Monday, the physician spends 1 hour and 15 minutes reviewing the patient's chart and test results, consulting with a specialist, and documenting a revised treatment plan. They see the patient on Tuesday. Code 99358 would be reported for Monday's prolonged service. Code 99359 is not reported because the additional time beyond one hour is less than 15 minutes.
Documentation should support the medical necessity of the prolonged service, specify the total time spent, describe the nature of the prolonged service (e.g., review of records, discussion with other professionals), and how it relates to the patient's ongoing management.
** Time spent on activities that are included in other separately reported services should not be counted toward prolonged services.
- RVU: Varies based on location and other factors. Check current Physician Fee Schedule.
- Modifier TC rule: Not applicable. This code does not have a technical component.
- Specialties:May be used by various specialties providing E/M services.
- Place of Service:Various (Outpatient hospital, Inpatient hospital, Office, Home, and other applicable places of service).