Wiki Prolonged Services - Direct Patient Contact

[AmandaW]

Any one have any luck billing & getting paid for a Prolonged Service WITHOUT Direct Patient Contact? 99358, +99359

Does Medicare still not cover those?

 

[Love Coding!]

99358 - billable or not billable??

Any one have any luck billing & getting paid for a Prolonged Service WITHOUT Direct Patient Contact? 99358, +99359

Does Medicare still not cover those?

I am wondering the same thing too. I have a physician that is billing for 99358, the patient was not present but was seen by this provider previously. The mom wanted to talk about the progression of her childs condition in private. What confuses me is that when I have done a search on 99358 United Healthcare shows this statement:

"This policy identifies when Oxford will separately reimburse physicians or other health care professionals for Prolonged Services with Direct Contact (Current Procedural Terminology {CPT®} codes 99354-99357) when reported in conjunction with companion Evaluation & Management (E/M) codes or other services/procedures.
"In accordance with The Centers for Medicare and Medicaid Services (CMS), Prolonged Services without Direct Patient Contact (CPT codes 99358-99359) will not be separately reimbursed.

I do not use the prolonged service codes, this is really new to me.

Thank you!

 

[CodingKing]

In accordance with The Centers for Medicare and Medicaid Services (CMS),

That is similar to the line the payer I work for uses when we apply the CMS guidelines to commercial plans. As Medicare is the largest payer, other payers model their guidelines to be similar. Also remember the existence of a CPT code does not mean its payable.