Does Medicare pay CPT 99358?

Practitioners were not permitted to bill the patient for services described by CPT® codes 99358 and 99359 since they are Medicare covered services and payment was included in the payment for other billable services. The CPT® prefatory language and reporting rules for these codes apply for Medicare billing.

How Much Does Medicare pay for 99358?

The CMS national payment rate for 99358 is $113.52 (the rate for 99359 is $54.78) with a Relative Value Unit (wRVU) of 2.10. This provides payment for the extensive medical management that occurs outside of the F2F visit.

What is procedure code 99358?

Codes 99358 and 99359 are used for non-face-to-face prolonged services by the billing physician/NP/PA when provided in relation to an E/M service on the same or different day as an E/M service.

What are the CPT codes for home visits?

A. Home services CPT codes 99341-99350 are paid when they are billed to report evaluation and management services provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home.

Can CPT code 99358 be billed alone?

Report CPT code 99358. Coding tip: Because the pediatrician performed more than 30 minutes of work on a single calendar date, non-direct prolonged services can be reported. Since 99358 is a stand-alone code, it can be reported on Friday before the initial encounter on Monday.

Can you bill for medical record review?

Record reviews ranging from 31 minutes to 90 minutes should be billed under CPT 99358. A review of medical records in excess of the 30 minutes included in 99455/56 and 90 minutes in total shall be billed by the half hour using CPT code 99359.

Does CPT 99358 need a modifier?

Since 99358 is a stand-alone code, it can be reported on Friday before the initial encounter on Monday. Report CPT codes 99204 (with modifier 25), 99358 (with modifier 25) and 96111. Coding tip: The encounter is being reported based on key components, which was 99204.

What does CPT code 99354 mean?

Prolonged Services with Direct Patient
Prolonged Services with Direct Patient Contact Codes 99354-99357 are used when a physician or other qualified health care professional provides prolonged service(s) involving direct patient contact that is provided beyond the usual evaluation and management (E/M) service in either the inpatient or outpatient setting.

Does CPT 99354 need a modifier?

Yes. They claim that 99354 and 96365 cannot be billed together without a modifier.

Can CPT code 99354 be billed alone?

CPT Code 99354 is a prolonged service CPT code add-on. It cannot be billed alone and must be billed with an appropriate procedure code. It fits into a sub-group of add-ons from 99354-99359 forming a subgroup of prolonged services codes.

What is place of service code 49?

Database (updated October 2019)

When to Bill 99358?

Choose 99358 and possibly +99359 based on all the time the physician spends on indirect prolonged services on one day. You need to spend at least 30 minutes of time to bill the first hour (99358) and at least 75 minutes to bill the first hour plus an additional 30 minutes (+99359) of prolonged time.

What is CPT code 99336?

CPT 99336, Under Established Patient Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services. The Current Procedural Terminology (CPT) code 99336 as maintained by American Medical Association, is a medical procedural code under the range – Established Patient Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services.

What is the CPT code for home services?

Home Services CPT Code range 99341- 99350. The Current Procedural Terminology (CPT) code range for Home Services 99341-99350 is a medical code set maintained by the American Medical Association.

What is Procedure Code 99053?

CPT 99053, Under Miscellaneous Medicine Services The Current Procedural Terminology (CPT) code 99053 as maintained by American Medical Association, is a medical procedural code under the range – Miscellaneous Medicine Services.