How many minutes is cpt code 99223?


Editorial team Published on

CPT code 99223 requires a minimum total time of 75 minutes on the date of the encounter when selecting the service based on time.

Time-Based Rules and Thresholds

  • Base Time: 75 to 89 minutes of total physician or qualified healthcare professional (QHP) time on the date of the service.
  • Prolonged Services: If total time reaches 90 minutes or more, you can report Medicare's prolonged service add-on code HCPCS code G0316. The first unit of G0316 triggers at 90 minutes (75 minutes base + 15 additional minutes), with subsequent 15-minute increments required for additional units.
  • Alternative Pathway: Code 99223 can also be selected based on a high level of Medical Decision Making (MDM) rather than time. Time and MDM are alternative pathways; you do not need to meet the time threshold if high MDM is properly documented.

What Activities Count Toward Total Time

  • Preparing to see the patient and reviewing prior medical records or test results.
  • Obtaining and reviewing the patient's history.
  • Performing the physical examination.
  • Ordering medications, laboratory tests, or other diagnostic procedures.
  • Communicating and discussing the patient's care with other healthcare professionals.
  • Counseling, educating, and discussing management with the patient, family, or caregivers.
  • Documenting clinical information in the electronic health record or chart.

What Time Does NOT Count

  • Travel time to the hospital or facility.
  • General educational teaching not directly related to the patient's management.
  • Time spent on other, separate patient encounters.
  • General administrative tasks unrelated to the specific care of this patient.