2025 CPT code 99418
(Active) Effective Date: N/A Evaluation and Management - Prolonged Services Feed
Prolonged inpatient or observation evaluation and management service time, with or without direct patient contact, beyond the required time of the primary service.
No specific modifiers are defined for this code by CPT.Modifiers may be necessary for other circumstances relating to the primary procedure performed.
Medical necessity for prolonged services must be supported by documentation showing the clinical circumstances requiring the additional time spent beyond the typical time for the primary service.This may include factors such as a complicated medical history, multiple comorbidities, extensive diagnostic testing requiring review, or complex decision-making regarding the patient's care.
The physician or other qualified healthcare professional personally provides prolonged service time with or without direct patient contact on the date of an inpatient evaluation and management service.The primary service must be selected based on time and only reported when the time threshold required to report the highest-level primary service has been exceeded by at least 15 minutes. Time spent performing separately reported services is not counted toward the prolonged service time.
In simple words: The provider spent extra time, beyond the typical time allotted, on an inpatient or observation evaluation and management service.This code is used for every 15-minute increment of this extra time.
Prolonged inpatient or observation evaluation and management service(s) 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 (List separately in addition to the code of the inpatient and observation Evaluation and Management service) (Use 99418 in conjunction with 99223, 99233, 99236, 99255, 99306, 99310) (Do not report 99418 on the same date of service as 90833, 90836, 90838, 99358, 99359) (Do not report 99418 for any time unit less than 15 minutes)
Example 1: A physician spends 90 minutes total time (including reviewing patient history, performing a physical exam, and counseling) with a new inpatient admitted for pneumonia (coded with 99223, which has a time threshold of 75 minutes). The additional 15 minutes can be reported with 99418., An established patient in observation status for chest pain receives 80 minutes of total time from the physician (99236, time threshold of 65 minutes).The additional 15 minutes is reported using 99418., A physician spends 105 minutes with a patient in a nursing facility (99306, time threshold of 90 minutes). The extra 15 minutes can be billed as 99418.
Total time spent by the physician or other qualified healthcare professional, including both direct (face-to-face) and indirect (non-face-to-face) time on the date of service, must be clearly documented. Documentation should also reflect the medical necessity of the prolonged time and how that time was spent (e.g., reviewing extensive records, coordinating care, complex decision-making).
** 99418 is intended to capture the additional resources required when a physician or other qualified healthcare professional spends significant extra time beyond the typical timeframe for an inpatient or observation E/M service.
- Revenue Code: M2A - HOSPITAL VISIT - INITIAL
- Global Days: 0 days. This code represents additional time spent on the same day as the primary service and doesn't have its own global period.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Fee schedules vary by payer and location.Consult the relevant fee schedule for specific reimbursement information.
- Specialties:This code is used by specialties that provide inpatient or observation care, such as Internal Medicine, Family Medicine, Hospitalists, Critical Care, and various surgical specialties during postoperative care.
- Place of Service:Inpatient Hospital, Observation, Nursing Facility