Is 99354 still valid?
Asked by: Braeden Predovic | Last update: April 17, 2025Score: 4.5/5 (64 votes)
When can you use the CPT code 99354?
99354 is described as an additional 30-74 minutes beyond the other CPT code. This means there is no preset time that you can bill 99354 for. So, the time of the original procedure code is important + a minimum of 30 minutes. See the 99354 time requirements section for further clarification.
What is the CPT code for prolonged visit 2024?
Prolonged services with or without direct patient contact on the date of an evaluation and management (E/M) service have two codes: 99417 and 99418.
Can you bill 90837 and 99354 together?
Let's say you had a 120-minute therapy session. The right way to bill this is to submit a claim for 90837 for the first hour then include the add-on CPT code, 99354 for the remaining time. However, if you only met with your client for 80 minutes, then you can only use 90837 to bill for the session.
Can 99214 and 99354 be billed together?
Yes. To code 99354 with 99214, the total face-to-face time spent with the patient would need to be at least 30 minutes beyond the 25 minutes typically spent in a 99214 visit.
Prolonged (Extended) Codes 99354 & 99355 DELETED!!
What replaced 99354?
In place of codes 99354 and 99355, use 99417. Code 99417 can be used to report prolonged services along with: 99245 (Office or other outpatient consultation for a new or established patient …)
What CPT codes are changing for 2024?
Several Category III codes will be converted to Category I codes in the Current Procedural Termi- nology (CPT®) 2024 code set, these include: dorsal sacroiliac (SI) arthrodesis; coronary fractional flow reserve (FFR) with computerized tomography (CT); coronary intravascular lithotripsy (IVL) interventions; ...
Can 99354 be billed with 90791?
You can also use CPT Code 90791 with Code + 99354 Add-on if the session is between 90 and 120 minutes. Add-On CPT Code +99355 for an additional 45 minutes of time in the session. Use 90791 + 99354 + 99355 for long sessions of greater than 120 minutes.
How do you bill for a 75 minute psychotherapy session?
To use the crisis code, the psychotherapy session must last for at least 30 minutes. If the session lasts for 75 minutes or more, you would use both 90839 and the add-on code 90840 when billing patients and filing claims. Whom do I contact if I have problems with Medicare billing and reimbursement?
Can prolonged services be billed with psychotherapy?
2023: No longer a prolonged care code for use with psychotherapy services. Prolonged codes 99354, 99355 were deleted in 2023. The existing prolonged care CPT code for office visits, 99417, may not be used with psychotherapy codes 90837 or 90838. There is no way to report prolonged care with psychotherapy.
How to bill for a prolonged office visit?
For CPT codes, use prolonged code 99417 for office services, consults, home and residence services and cognitive assessment; For hospital and nursing facility codes, use 99418. CMS has three prolonged care codes.
What are the new changes in E&M 2024?
The 2024 E&M changes and updates include continued emphasis on selecting codes based on Medical Decision Making (MDM) or total time spent. Additionally, 2024 e&m guidelines for time documentation for E&M codes now requires the "must be met or exceeded" standard, replacing the previous start-and-stop time method.
Can you bill two emergency room visits on the same day?
Yes, in some cases, you can bill two E&M (Evaluation and Management) codes for the same patient on the same day, but it depends on payer rules and documentation requirements.
What is the CPT code for prolonged services in 2024?
New Guidelines for Prolonged Services
CPT® add-on codes +99417 and +99418 describe prolonged services with or without direct patient contact on the date of an E/M service in the outpatient or inpatient setting, respectively.
What is the CPT code for extended psychotherapy session 2024?
For a 2-hour therapy session, you can use 90837 CPT code for the first 60 minutes and 90838 CPT code for each additional 30 minutes.
What is the prolonged service code for 90837?
So are you out of luck and stuck with just billing 90837? Add-on CPT Code 99354 is defined as a prolonged services code and is defined as an extra 30-74 minutes of therapy. 99354 used to only be allowed by Medical Doctor's, but has since expanded and is applicable to 90837 and 90487.
How do you bill 75 minutes in critical care?
Code 99292 is reported when the total critical care time extends beyond the initial 74 minutes allotted by 99291. If the total critical care time is in the 75-104 minute range, 99292 is reported in addition to 99291. An additional 99292 is reported for each additional 30-minute block of time reached.
Can I bill 90837 for 50 minutes?
Time Requirements and Service Criteria for Billing 90837
Code 90837 is for 60-minute therapy sessions, defined as 53 minutes or longer. Anything less than 53 minutes would use code 90834 (45-minute session). For 90837, the actual session time must be documented in your notes. Rounding up or down is not allowed.
What is the 8 minute therapy rule in billing?
Billing rules for the 8-minute rule. When Medicare reviews your claim, they will divide the total minutes for all timed services by 15. If the result of the equation leaves at least 8 minutes remaining before hitting another 15-minute increment, you can bill an extra unit.
How to bill 75 minutes of psychotherapy?
90839 Psychotherapy for crisis (a crisis psychotherapy session requiring urgent assessment and history of crisis state mental status exam, and disposition), 60 minutes** 90840 Additional code for an additional 30 minutes (75 minutes and over with the client), used with 90839.
How to bill for extended therapy sessions?
Billing Extended Sessions for Individual Therapy
It's important to note that if you are seeing a client for 60 minutes or under, make sure to bill using CPT codes 90832, 90834, or 90837 alone. Do not bill using add-on codes if sessions are not extended. Services performed outside of business hours.
Does 90791 pay more than 90837?
Yes! 90791 almost always pays more per session than 90834 or 90837. The exact payment depends on the credentialing of the provider rendering services and the insurance plan.
What does the red dot before a CPT code indicate?
Part of the purpose of the code symbols included in the CPT manual is to tell coders which codes are new, resequenced, or revised procedure codes. The new procedures are marked with a red dot. Heavily revised procedures are marked with a blue triangle.
What are the new updates for AAPC 2024?
The ICD-10-CM code set update for fiscal year (FY) 2024 adds 395 new codes, deletes 25 existing codes, and revises 22 codes (nine of which are to the short title only). There are also 131 new headers and four revised headers. There are not changes in every section from A to Z, but it's close!
Where can I look up CPT codes for free?
The Centers for Medicare & Medicaid Services offer a free search (CPT code lookup) for RVU for every CPT code. Users can also request a CPT/RVU Data File license from the AMA to easily import codes and descriptions into existing claims and medical billing systems.