Wiki Prolonged services coding

[shatfield]

We have a doctor and an APRN that are certified lactation consultants. They usually spend 45min-90min with a mom and newborn doing a lactation visit. We have been billing the appropriate E/M code (99213-99215) along with 99354 and 99395 (if needed-depending on time). We are having trouble with insurance paying for the prolonged services code. We have tried with -25 & -59 and without the modifiers. Anyone else have any suggestions on how our providers can be paid for this extended amount of time they are spending with these patients?

 

[VictoriaOlson]

I would suggest that you check with the insurance payers. We occasionally bill with the prolonged services codes and have found that at least one insurance company requires a prior authorization/retro authorization in order for that code to be considered.