Wiki Prolonged Service Non Face to Face

[LOUISE SLACK]

Hello fellow coders,
I am looking for a good list of what the non face to face provider activities would be to qualify for Non F2F PS, 99358 & 99359. We do have some carriers that actually pay this service and I believe Medicare does too.
The health system I work for has a tip sheet that says peer to peer reviews with insurers is allowed, but I am wondering about long telephone calls to a prior auth number for a patients medication. This doesn't happen often but since the provider was on the phone for an hour with an insurance prior auth department I want to let them charge the 99358.
Thanks everyone have a great weekend.
Louise

 

[SharonCollachi]

As long as they documented it, I would say it is valid. They were actually speaking to someone for over an hour? Or they were on hold for over an hour? Hold time doesn't count - you're not actually doing anything, and a staff member can babysit the phone until someone picks up.

 

[LOUISE SLACK]

As long as they documented it, I would say it is valid. They were actually speaking to someone for over an hour? Or they were on hold for over an hour? Hold time doesn't count - you're not actually doing anything, and a staff member can babysit the phone until someone picks up.

Thank you for your response. The physician said the phone calls were with the pharmacy and the Medicaid Prior Auth. She said the prior auth service used to be on line and she could easily fill out the form on line but now she has to call and the review person at Medicaid was very slow in entering the criteria so I do not believe it was hold time. I will make sure to emphasize to providers that only actuall talking time counts and not hold time.

Thanks again!