Thanks. I found the below information in CPT Assistant August 2012.
Prolonged Service (Physician or Other Qualified Health Care Professional)
Another change denotes the reporting of prolonged services when performed by either a physician or other qualified health care professional. The titles of the Prolonged Service With Direct Patient Contact and Prolonged Service Without Direct Patient Contact subsections reflect removal of physician-specific references. In some circumstances in the CPT code set, instruction may specify services that are limited to the performance by certain practitioners (ie, medical nutrition therapy, home health, medical genetics, and genetic counseling professionals) to differentiate these services from those that are currently reportable with existing CPT codes requiring a higher level of professional expertise. However, for the most part, it is not the intent of the code set to define the appropriate professional designation for provision of the service. These designations are based upon the individual's performance of the professional service within his/her scope of practice and ability to independently report that professional service, and upon the education, training, licensure/regulation (when applicable), and facility privileging (when applicable) qualifications.
As indicated in the Introduction of the CPT codebook, a “physician or other qualified health care professional” is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. [B]These professionals are distinct from “clinical staff.” A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation, and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report the professional service. Other policies may also affect who may report specific services.[/B]
The CPT code set is a work of medical nomenclature consisting of a set of codes, descriptions, and guidelines that describes procedures and services performed by physicians and other health care providers. The CPT code set is intended to be consistent with contemporary medical practice and to reflect procedures and services that are “performed by many practitioners in clinical practice in multiple locations.… Inclusion or exclusion of a procedure does not imply any health insurance coverage or reimbursement policy.”
The CPT code set avoids statements about who is or is not qualified to perform the services and procedures described in the CPT code set, other than to state that the practitioner must be qualified. The introductory section of the CPT codebook describes the neutrality of CPT in the following excerpt:
It is important to recognize that the listing of a service or procedure and its code number in a specific section of this book does not restrict its use to a specific specialty group. Any procedure or service in any section of this book may be used to designate the services rendered by any qualified health care professional.
The CPT Editorial Panel is required to adhere to the policy of neutrality with respect to identification of the type of provider that can perform a procedure or service that is described in the CPT code set. CPT code descriptions, parenthetical instructions, accompanying guidelines, and related CPT Assistant articles that give coding guidance should not specify, except in limited circumstances, who is qualified to perform a specific procedure or service or who is permitted to use a code.
Therefore, the title for the prolonged services codes has been revised to eliminate the reference to “physician” to allow more accurate representation of the services provided and for consistency with the guidance cited above to refrain, where possible, from inclusion of provider reference or any explicit or implicit direction as to who is or is not qualified to perform the service or procedure in CPT descriptors, guidelines, or related CPT Assistant articles.
Note: Although the above reporting reflects the intent of the CPT coding system, third-party payers may have different policies regarding the use of the CPT prolonged services codes 99354-99359. You may wish to contact your local third-party payers for specific reimbursement/payment policy guidelines.