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This information applies to prolonged services relative to office and outpatient services (99202-99215) performed on and after 1/1/2021.

For information for prolonged services prior to 1/1/2021 see topic Prolonged Services Prior to 12/31/2020

Prolonged Services On or After 1/1/2021

New HCPCS Code Effective 1/1/2021: G2212

  1. How has coding and billing for prolonged office and outpatient services changed in 2021?

    Answer: CMS has announced HCPCS G2212 to describe each shorter prolonged service period of 15 minutes during which a physician or Qualified Health Provider (QHP) performs work that is critical to the patient’s care. G2212 is billed in the number of units that describe actual time spent. Added 1/15/2021
  1. Can G2212 be added when a service is coded based on either time or complexity of MDM?

    Answe
    r: G2212 can only be added when coding has been based on time. Added 1/15/2021
  1. How do previous CMS suggested timeframes apply to services in 2021?

    Answer
    : CMS has announced new timeframes for time-based coding in 2021. When billing based on time, time for the highest level of coding (e.g., 99205/99215) must be exceeded by 15 minutes before a unit of G2212 is added to the claim, and each subsequent 15 minutes of time may be represented by additional units of the service. Added 1/15/2021
  1.  Does G2212 represent only time spent face-to-face?

    Answer
    : G2212 represents both time spent by the provider both face-to-face and non-face-to-face on the date of the face-to-face E/M service. Added 1/15/2021
  1. Are prior codes 99354-99356 still applicable for prolonged services in the office and outpatient setting?

    Answer
    : 99354-99356 are no longer applicable for prolonged services in the office and outpatient settings. Added 1/15/2021
  1. Is 99358-99359 still applicable coding for prolonged services that are not face-to-face?

    Answer
    : 99358-99359 are no longer applicable when time is spent non face-to-face. Added 1/15/2021
  1. Can 99358-99359 still be used to represent non face-to-face time spent on a date other than the associated face-to-face service?

    Answer
    : No, CMS has stated in the 2021 Physician Fee Schedule Final Rule that they have discontinued the use of CPT 99358-99359 with office or other outpatient visits. Added 1/15/2021
  1. Can prolonged service time spent by clinical staff (not by the performing/billing provider) be represented by the new prolonged service code G2212?

    Answer
    : Time spent by clinical staff cannot be counted toward the base time or prolonged time of an office or outpatient service. Added 1/15/2021
  1. When two practitioners split/share a service, how is total time counted?

    Answer
    : The time spent by both practitioners can be counted cumulatively in coding the service; time spent jointly by the two practitioners with the patient can only be counted once in coding the service. Added 1/15/2021 

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Prolonged Services On or After 1/1/2021
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