Prolonged Services Billing

Prolonged services are time-based and involve a single same-day evaluation/management encounter. Please review these tips to help expedite claims for prolonged services.

Use of HCPCS Codes G2212 and G0316

To align TRICARE policy with Medicare policy:

In addition to Current Procedural Terminology (CPT®) codes 99205, 99215 and 99483, providers should use HCPCS code G2212 (each additional 15 minutes, but not less than 15 minutes), when billing for prolonged outpatient services, or
In addition to CPT codes 99223, 99233 and 99236, providers should use HCPCS code G0316 (each additional 15 minutes, but not less than 15 minutes), when billing for prolonged hospital inpatient or observation services.

Medical Record and Claim Documentation

Clearly document the amount of time spent with a patient in the medical record and associated claim. Including this information in the medical record and claim submission will help shorten the amount of time needed to process the claim. Be sure to include:

Encounter start and stop times and/or
Total time spent with patient

CPT Code 99417 Not Accepted by TRICARE

TRICARE does not accept CPT code 99417 as an allowable add-on code for prolonged services. Claims listing this code will reject for a corrected procedure code.

For more information visit our Claims page.