CPT Code Lookup Tool
Use this free CPT Lookup Tool to search for Current Procedural Terminology (CPT) codes, descriptions, and related details — designed to help streamline and simplify your medical billing process.
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Office or other outpatient visit
Evaluation and management of an established patient...
Information
This code is for use in medical billing and coding.
Information
This code is part of the section of CPT codes.
Office or other outpatient visit for the evaluation and management...
Note
This description reflects the 2021 E/M coding guidelines.
Information
codes are used to report evaluation and management services provided in various settings.
Information
RVUs are used to determine the fee for a service under the Medicare Physician Fee Schedule.
Information
This code is commonly used by primary care providers, but may be used by any specialty providing office visits.
Significant, separately identifiable E/M service
Information
Modifiers provide additional information about the service provided.
Detail About CPT 99354
Related CPT Codes
| CPT Code | Description |
|---|---|
| 99355 | Prolonged service in the office or other outpatient setting; each additional 30 minutes beyond first hour |
| 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires 60 minutes |
| 99417 | Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure, requiring total time with direct patient contact beyond the usual service |
| 99358 | Prolonged evaluation and management service before and/or after direct patient care; first hour |
| 99415 | Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first 30 minutes |
Commonly Billed With
- CPT 99353 - Prolonged service in the office or other outpatient setting; first hour (List separately in addition to code for office or other outpatient Evaluation and Management service)
Often billed together when extended time is spent with the patient beyond the usual service.
- CPT 99214 - Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 25 minutes face-to-face with the physician or other qualified healthcare professional
Commonly billed when a detailed evaluation is performed along with prolonged services.
Clinical Scenarios
Scenario 1
A patient presents with complex medical issues requiring extensive discussion and counseling, leading to a prolonged visit beyond the typical duration.
Scenario 2
During an office visit, a patient experiences a medical emergency necessitating immediate attention and extended care, resulting in prolonged direct patient contact.
Scenario 3
A patient with multiple chronic conditions requires comprehensive evaluation, management, and coordination of care, leading to a prolonged encounter exceeding standard timeframes.
Frequently Asked Questions
Q1: When should I use CPT 99354?
CPT 99354 should be used when providing prolonged services in an office or outpatient setting that require direct patient contact beyond the usual service by at least 30 minutes.
Q2: What documentation is required for CPT 99354?
Documentation must include the total duration of direct patient contact time beyond the usual service provided, along with the reason for the extended encounter.
Q3: What are common modifiers used with CPT 99354?
Common modifiers used with CPT 99354 include modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and modifier 59 (Distinct procedural service).
Q4: What are common denial reasons for CPT 99354?
Common denial reasons for CPT 99354 may include lack of documentation supporting the need for prolonged services or failure to meet the minimum time requirement beyond the usual service.
Q5: How does CPT 99354 differ from similar codes?
CPT 99354 specifically pertains to prolonged services requiring direct patient contact beyond the usual service by at least one hour in an office or outpatient setting. It is distinct from other codes that address different types or durations of prolonged services.
Q6: Can CPT 99354 be reported without a primary E/M code?
No, CPT 99354 must always be reported in conjunction with a primary E/M code. It cannot be billed alone.
Q7: Are there any specific specialties that frequently use CPT 99354?
Certain specialties such as Internal Medicine, Family Medicine, Pediatrics, and Psychiatry commonly utilize CPT 99354 due to their focus on comprehensive patient care that may require extended face-to-face time.
Q8: How does billing for CPT code 99354 impact reimbursement?
Billing for CPT code 99354 allows providers to receive additional reimbursement for prolonged services that go beyond standard visit times. Proper documentation is essential to support billing and ensure accurate reimbursement.
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Q9: Can multiple units of CPT code 99354 be reported for a single encounter?
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Multiple units of CPT code 99354 can be reported if the total prolonged service time exceeds one hour. Each additional unit represents an additional hour of prolonged services provided. Proper documentation is crucial to support billing for multiple units.
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