Reimbursement Outlook: Pay Varies for Prolonged Services

Medicare will reimburse you for prolonged service codes only with direct (face-to-face) patient contact (99354-99357). Since Medicare has not established RVUs for codes +99358 and +99359 (Prolonged evaluation and management service before and/or after direct [face-to-face] patient care), many third-party payers also refuse to pay for these services. You can use codes 99358 and 99359 to report a physician's time researching or contacting other physicians for information, but in general these codes are seldom useful, Carr says.
 
Medicare and third-party payers show a mixed response to the direct prolonged service codes (99354-99357), says Judy Richardson, senior consultant with Hill & Associates in Wilmington, N.C. Many carriers will request documentation before deciding to pay, and some third-party payers do not accept prolonged service codes in addition to high-level E/M service codes, she says. Contact your local Medicare carrier and other payers to see exactly when and how they will pay for prolonged services.

- Published on 2004-03-12