# 99358 / 99359 Prolonged E/M



## bmanus (Nov 8, 2012)

Can a PA bill for 99358? The PA spent over thirty minutes discussing patient care with Rehab facility for coordination of care.


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## Naveen Rachagolla (Nov 9, 2012)

Prolonged services without direct patient contact (99358-99359)

This service is to be reported in relation ot other physician or other qualified health care professional services, including evaluation and management sevices at any level.

This prolonged service may be reported on a different date then the primary service to which it is related.

*Reference CPT 2013 Professional page # 32*

Contractors may not pay prolonged services codes 99358 and 99359, which do not require any direct patient face-to-face contact (e.g., telephone calls). Payment for these services is included in the payment for direct face-to-face services that physicians bill. The physician cannot bill the patient for these services since they are Medicare covered services and payment is included in the payment for other billable services.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

Payment for the PA’s services may only be made to the PA’s employer, not to the PA himself/herself. In other words, the PA cannot individually enroll in Medicare and receive direct payment for his or her services. This also means that the PA does not reassign his or her benefits to the employer, since the employer must receive direct payment anyway.

The PA’s employer can be either an individual or an organization. If the employer is a professional corporation or other duly qualified legal entity (e.g., limited liability company) in a State that permits PA ownership in the entity (e.g., as a stockholder, member), the entity may bill for PA services even if a PA is a stockholder or officer of the entity – so long as the entity is eligible to enroll as a provider or supplier in the Medicare program. PAs may not otherwise organize or incorporate and bill for their services directly to the Medicare program, including as, but not limited to, sole proprietorships or general partnerships. Accordingly, a qualified employer is not a group of PAs that incorporates to bill for its services. Moreover, leasing agencies and staffing companies do not qualify under the Medicare program as providers or suppliers of services.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c15.pdf


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## bmanus (Nov 9, 2012)

Thank you.


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