2025 CPT code 99415
(Active) Effective Date: N/A Evaluation and Management - Prolonged Services Feed
Prolonged clinical staff service during an E/M service in the office or outpatient setting, direct patient contact with physician supervision; first hour.
No specific modifier rules apply to 99415.
Prolonged clinical staff time is medically necessary when the patient's condition or circumstances require more time than typically allotted for an E/M service. This could include situations where extensive patient education, counseling, or emotional support is needed.
In addition to the highest time in a range included in the descriptor for a primary evaluation and management (E/M) service, the clinical staff spends additional time on that office or outpatient service under the provider’s direction.The service requires direct contact with a patient. Use this code for the first hour of additional time spent with the patient. Because you must meet the halfway mark for the time listed in the code to report it, you may use this code once the clinical staff reaches 30 minutes of additional time.
In simple words: The clinical staff spends additional time directly with the patient during an office or outpatient visit. This code covers the first hour of that extra time spent by the staff under the doctor's supervision.
Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)(Use 99415 in conjunction with 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215) (Do not report 99415 in conjunction with 99417)
Example 1: A patient with complex medical history requires extensive education and counseling regarding their new medication regimen during a routine office visit. The clinical staff spends an additional 45 minutes beyond the typical service time providing this education and counseling, under the direct supervision of the physician. 99415 is reported in addition to the appropriate E/M service code., A pediatric patient with autism has a difficult time adjusting to the medical office environment during a follow-up visit. The clinical staff spends an extra hour calming the child and engaging them in play therapy to facilitate the examination and discussion with the physician. 99415 is reported in addition to the appropriate E/M service code., An elderly patient with cognitive impairment requires assistance with completing necessary paperwork and understanding discharge instructions after an outpatient procedure. The clinical staff spends an additional 30 minutes with the patient and their family, explaining the instructions and ensuring all forms are properly filled out, under the physician's supervision. 99415 is reported in addition to the appropriate E/M service code.
Documentation should support the medical necessity of the prolonged clinical staff time. The total time spent by clinical staff, the activities performed, and the physician's direct supervision should be clearly documented in the patient's medical record.
** Time spent performing separately reported services (other than E/M) is not counted towards prolonged service time. When face-to-face time is non-continuous, use only the face-to-face time provided to the patient/family by the clinical staff. 99415 may be reported for no more than two simultaneous patients, and the time reported is devoted to a single patient.
- Place of Service:Office, On Campus-Outpatient Hospital, and Off Campus-Outpatient Hospital