Wiki 99417

[Carol Hudgens]

Has anyone else had problems with getting insurance carriers to pay for 99417. I have my time documented well along with what was discussed, etc and United Healthcare states missing, incomplete, invalid procedure code".

 

[sls314]

I don't think UHC accepts 99417. My understanding is that they prefer G2212.

Here is a copy of UHC's prolonged services policy for commercial policies:

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Prolonged-Services-Policy.pdf

 

[Ckrogers]

My question is if UHC prefers G2212 do they require the Max time + 15 minutes, per G2212 guidelines, or Threshold time + 15 minutes, per CPT guidelines for 99417? 69 minutes vs. 60 minutes for 99215 base code makes a big difference.

 

[sls314]

My question is if UHC prefers G2212 do they require the Max time + 15 minutes, per G2212 guidelines, or Threshold time + 15 minutes, per CPT guidelines for 99417? 69 minutes vs. 60 minutes for 99215 base code makes a big difference.

I suspect that's the whole point of some commercial payers preferring G2212.

 

[shanamarie]

My question is if UHC prefers G2212 do they require the Max time + 15 minutes, per G2212 guidelines, or Threshold time + 15 minutes, per CPT guidelines for 99417? 69 minutes vs. 60 minutes for 99215 base code makes a big difference.

I would review 99417/G2212 again. When the time ranges were removed for 2024, CPT and CMS times should be the same. Or at least it is for my Mac, which is NGS.

 

[rachaelwilleford]

I would review 99417/G2212 again. When the time ranges were removed for 2024, CPT and CMS times should be the same. Or at least it is for my Mac, which is NGS.

NGS updated, but many of the MACs (and CMS) have not updated guidance yet to reflect the change.