The world of healthcare billing is always evolving, which can make it difficult for providers to stay current with new codes. CPT code 99355 was a vital code for reporting prolonged services beyond the first hour. This add-on code helped providers get compensated for additional time spent with patients, ensuring that extra care was properly reimbursed.
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Recently, significant changes to prolonged service codes, including CPT 99355, have created confusion in the billing community. Billing specialists are seeking clarity on how to report these services correctly. Understanding when and how to use these codes is crucial for accurate reimbursement.

This guide will explore the ins and outs of CPT 99355, its role in billing, and the new codes that replace it. We’ll also provide tips for better billing practices and how you can avoid common pitfalls.

What is CPT 99355 and When to Use It

CPT 99355 was used to report additional time spent with a patient beyond the first hour of prolonged services. It could only be billed in conjunction with CPT 99354 and could not be used independently. 99355 accounted for each extra 30 minutes beyond the initial hour, ensuring providers were compensated for the full time spent with patients.

Prolonged Service Codes: Definition and Purpose

CPT 99355 is an add-on code used in conjunction with other E/M codes to ensure accurate reporting of extended patient visits. This code was specifically designed to account for the extra time spent with patients beyond the initial hour of service, providing fair compensation for prolonged care.

Relationship to Base Code 99354

CPT 99355 must always be used with CPT 99354, which covers the first hour of prolonged service. The correct use of both codes helps providers document and report the full time spent on patient care. For example, if a doctor spends 100 minutes with a patient, CPT 99354 covers the first hour, and CPT 99355 covers the additional 30 minutes.

CPT 99355 Billing Guidelines and Documentation

Proper billing for CPT 99355 requires clear documentation to demonstrate the necessity for prolonged service. To qualify for this code, healthcare Specialists must ensure the following:

• Start and end times for the additional service duration
• A description of the clinical activities performed during the extra time
• Medical necessity documentation showing why the extended time was required
• Provider signature and credentials confirming the service provided

Recent Changes to CPT 99355 and Replacement Codes

In 2023, CPT 99355 was officially deleted, and new codes were introduced to replace it. The updates were designed to simplify the process of reporting prolonged services and provide more specific guidelines for healthcare providers.

The new G0316, G0317, G0318 codes now serve as replacements, with clearer time increments and more specific use cases for both facility and non-facility settings. These codes align with modern healthcare practices and provide more accurate reimbursement models.

New Replacement Codes Overview

The transition from CPT 99355 to new codes like 99417 and G2212 marks a significant shift. The new codes offer more precise guidelines for reporting prolonged services, with clearer rules for the following:

• 15-minute increments for accurate time-based billing
• The ability to use multiple units depending on the length of the service

How Vinali Group Can Help with CPT 99355

At Vinali Group, we specialize in helping healthcare providers navigate the complexities of CPT 99355 and its replacement codes. Our team of RCM experts provides end-to-end support, from training on proper documentation and coding practices to offering tailored solutions for compliance and reimbursement optimization.

We understand that the transition to new codes can be challenging, but with Vinali Group by your side, your practice can streamline billing processes, minimize denials, and maximize revenue. Let us help you stay ahead of the curve with the latest coding guidelines.

👉 Ready to optimize your billing processes and improve your revenue cycle management? Contact Vinali Group for expert support today.