2025 CPT code 99417
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Prolonged Services Feed
Prolonged outpatient evaluation and management service time with or without direct patient contact beyond the required time of the primary service, when the primary service level has been selected using total time (each 15 minutes of total time).
Modifiers may be applicable depending on the payer and the specific circumstances of the service.
Prolonged services are medically necessary when the patient's condition requires additional time beyond the usual time allotted for the primary service. The documentation should clearly justify the need for the extended duration of care.
The provider delivers prolonged E/M services beyond the typical time for the primary service, using either direct face-to-face time or non-face-to-face time spent on activities related to the patient's care on the same date of service.
In simple words: The provider spends additional time on an outpatient evaluation and management service. This code is used for each additional 15 minutes beyond the minimum required time.
Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services).
Example 1: A new patient has a complex medical history requiring a prolonged office visit. The provider spends 75 minutes in total time with the patient, exceeding the 60-minute threshold for code 99205. Code 99417 is reported in addition to 99205., An established patient with cognitive impairment requires extensive care planning. The visit extends beyond the typical time for code 99483 by 20 minutes. Code 99417 is reported in addition to 99483 for the extra time spent., A patient receives prolonged outpatient consultation services, exceeding the time for code 99245 by 25 minutes. In this scenario, code 99417 is reported along with the primary code 99245 for the additional time spent.
Documentation must support the medical necessity of the prolonged service time, the total time spent on the date of service (both direct and indirect), and the primary E/M service provided.
** Always check payer-specific guidelines as they may have different rules for prolonged services.Medicare has specific guidelines regarding the use of prolonged service codes.
- Global Days: 0
- Payment Status: Active
- Specialties:Applicable to various specialties providing E/M services in outpatient settings.
- Place of Service:Office, Home, Outpatient Hospital, and other places where outpatient E/M services are rendered.