tci Medicare Compliance & Reimbursement - 2017 Issue 7

Industry Note: Prolonged Services Options Have Their Limitations

Remember those E/M codes for prolonged services that CMS offered up back in the fall and applicable in 2017? New guidance suggests that those unbundled, CPT® options for non-face-to-face, prolonged care will be limited to two hours total. In its final rule for the 2017 Medicare Physician Fee Schedule (MPFS) in November 2016 (see more details on the 2017 MPFS in Medicare Compliance and Reimbursement, Vol. 42, No. 22), CMS pledged separate payments for some E/M services that fell under CPT® codes 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) and 99359 (Prolonged...

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