Wiki 99417

[Carol Hudgens]

Has anyone else had problems with getting insurance carriers to pay for 99417. I have my time documented well along with what was discussed, etc and United Healthcare states missing, incomplete, invalid procedure code".

 

[sls314]

I don't think UHC accepts 99417. My understanding is that they prefer G2212.

Here is a copy of UHC's prolonged services policy for commercial policies:

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Prolonged-Services-Policy.pdf

 

[Ckrogers]

My question is if UHC prefers G2212 do they require the Max time + 15 minutes, per G2212 guidelines, or Threshold time + 15 minutes, per CPT guidelines for 99417? 69 minutes vs. 60 minutes for 99215 base code makes a big difference.

 

[sls314]

My question is if UHC prefers G2212 do they require the Max time + 15 minutes, per G2212 guidelines, or Threshold time + 15 minutes, per CPT guidelines for 99417? 69 minutes vs. 60 minutes for 99215 base code makes a big difference.

I suspect that's the whole point of some commercial payers preferring G2212.

 

[shanamarie]

My question is if UHC prefers G2212 do they require the Max time + 15 minutes, per G2212 guidelines, or Threshold time + 15 minutes, per CPT guidelines for 99417? 69 minutes vs. 60 minutes for 99215 base code makes a big difference.

I would review 99417/G2212 again. When the time ranges were removed for 2024, CPT and CMS times should be the same. Or at least it is for my Mac, which is NGS.