Wiki CPT 99354

[nyauco91787]

Provider initially seen the patient for depression among other issues, billed 99214, however, patient stood in the office over an hour. The doctor continued her visit and billed an additional 99354, however, claim keeps being rejected. I've never billed or coded 99354, can someone help me understand if this code is correct on this visit or does the doctor needs to bill it on a seperate claim? Thank you so much

 

[jkyles]

Hi there,

There's a lot going on here, but to summarize: You can't report 99354 with office visits, effective Jan. 1, 2021.

Review the guidelines for time-based billing of office visits and prolonged services in your CPT manual. You also need to check the payer's policy to see whether you should report the CPT code or the G code because that will determine how many units of prolonged service you can bill.