2025 CPT code 99358
(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; first hour.
Modifiers may be applicable depending on the specific circumstances. Refer to current CPT guidelines for modifier usage.
The prolonged service must be medically necessary and contribute significantly to the patient's evaluation, treatment, or management. It should not be routine or simply administrative in nature.The medical record should clearly justify the need for the extended time spent.
The physician or other qualified healthcare professional is responsible for performing the prolonged non-face-to-face service, which must be medically necessary and contribute to the patient's overall care plan.Documentation should clearly reflect the nature and duration of the service provided.
In simple words: This code covers the first hour of extra time a doctor spends working on your case outside of a regular appointment, on a different day than the appointment, like reviewing records or talking to other medical staff. This extra time is only billed if it's at least 30 minutes long and is part of your continued care.
This code is used for prolonged evaluation and management services provided on a date other than the date of the face-to-face encounter.It represents the first hour of non-face-to-face prolonged service and is reported once per day. The total time spent on prolonged service is aggregated, even if not continuous. This code is used in conjunction with other E/M services when the provider spends additional time on non-face-to-face activities related to the patient's care, such as reviewing extensive records, communicating with other professionals, or coordinating care. The time spent must relate to a service or patient where face-to-face care has occurred or will occur, contributing to ongoing patient management.
Example 1: A physician spends an hour reviewing a complex patient's medical history, lab results, and imaging studies from prior visits and consultations in preparation for an upcoming surgery., Following a hospital discharge, a physician spends 45 minutes on the phone with the patient's family, explaining the discharge instructions, medication regimen, and follow-up care plan., A physician spends 75 minutes coordinating care with multiple specialists involved in a patient's complex case, including reviewing their recommendations and developing a comprehensive treatment plan.
Documentation must support the medical necessity of the prolonged service and its direct relationship to an E/M encounter. The total time spent, a description of the activities performed (e.g., record review, communication with other providers), and how it contributes to the patient's care should be clearly documented.
** As of December 1st, 2024, this information reflects the current understanding of CPT code 99358.Always verify coding guidelines and fee schedules with the appropriate resources for the most up-to-date information.
- RVU: Refer to current Physician Fee Schedule.
- Specialties:May be applicable to various specialties when prolonged non-face-to-face services are necessary for patient care.
- Place of Service:Applicable in various settings, as the service is non-face-to-face.